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Biometric Factors Affecting Vaulting After Intraocular Collamer Lens Im-
plantation.
David Sung Yong Kang1,2, Jin Young Choi1, Hun Yang1, Ik Hee Ryu1, Hee Sun Kim1,
Seong Bae Park1, Jin Kuk Kim1 and Chan Yun Kim2.1. Clean Vision Eye Center, GangNam, Seoul, Korea. 2. Yonsei University College of Medicine, Seoul,
Korea.
The Authors have No Financial Interest in the Subject Matter of this Poster.
OBJECTIVES 1. To Evaluate Pre-operative Biomet-
rics Predictive of Final ICL Vaulting.
2. To Evaluate Manufacturer Recom-mendation Lens Size on Final ICL Vault Outcome.
METHODS Retrospective Observational Non-Interventional Case Series
Duration: 2009.9 – 2010. 4 At Least 6 months F/U
Participants: 133 Eyes of 67 pts Im-planted with 120 sized V4 Intraoc-ular Collamer Lens (ICL, Starr Surgical).
METHODSPre-Op. Biometric Evaluation:
1. Corneal White-to-White(WTW): Keratograph (70600, Oculus)
2. Anterior Chamber Depth (ACD) Measurement: A-Scan (SP-3000,Tomey,Japan)
3. Sulcus-to-Sulcus Measurement(STS): Ultrasound Bio-Microscopy(UBM,Aviso,Quantel Medical)
4. Angle-to-Angle(ATA) Measurement, Angle Parameters (AOD, TISA 500 & 750) Anterior Segment Optical Coherence Tomography (OCT): (Visante OCT, Carl Zeiss Meditech, Dublin,CA)
5. Anterior Chamber Volume Assessment: Pentacam (Oculus)
Post-Op. Biometric Evaluation: 1. ICL Vaulting2. Angle Parameters (AOD & TISA 500 & 750)
All by Visante OCT.
METHODSNo. of Eyes Reason Measures POD #
Weeks
2 High V Exchanged # 1 & 3
2 Low V Exchanged # 4
2 Non-Patent PI High V
Further PI # 2 & 3
5 Steroid In-duced OHTN
Anti-HTN Medication
1 F/U Loss
Final In-clusion
121
Exclusion Criteria
V: Vaulting, PI:Laser Peripheral Iridotomy, OHTN: Ocular Hypertension, F/U: Follow up
METHODS
High Vault: >750 Microns
Optimal Vault:250 – 550 Microns
Low Vault: <250 Microns
Evaluated at POD # 6 Months With Anterior Segment OCT
Low V(n=10)
P value( Low vs Op-
timal)
Optimal V(n=87)
P value( High vs Op-
timal)
High V(n=24)
Total(n=121)
Age 29.70(4.55) 0.0003 24.97 (3.69)
0.42 25.67 (4.10)
Sex(M:F) 2:8 0.49 32:55 0.67 10:14
AXL 26.58 (1.11)
0.09 27.22 (1.15)
0.30 27.52 (1.46)
ACD 3.12 (0.18) 0.004 3.31 (0.19) 0.49 3.34 (0.20)
ACV 191.8 (28.35)
0.03 209.7 (22.99)
0.46 205.8 (20.78)
WTW 11.64 (0.11)
0.0003 11.85 (0.24)
0.0006 11.70 (0.17)
ATA 12.18 (0.21)
0.84 12.16
(0.32)0.003 11.94 (0.23)
STS 11.61 (0.23)
0.08 11.76 (0.21)
0.009 11.63 (0.21)
AOD500 0.44 (0.16) 0.14 0.53 (0.19) 0.35 0.57 (0.17)
AOD750 0.63 (0.21) 0.11 0.76 (0.24) 0.45 0.81 (0.21)
TISA500 0.15 (0.05) 0.14 0.18 (0.06) 0.43 0.19 (0.06)
TISA750 0.28 (0.09) 0.11 0.34 (0.12) 0.41 0.37 (0.10)
RESULTS
The t-test Procedure; SPSS Ver12.0; p<0.05 considered Siginificant
Specificities at Fixed Sensitivi-ties
Variable Sensitivity(%)
Specificity(%)
Cut-Off Value
WTW 85 37.5 11.65
STS 81.4 39 11.56
ATA 80.2 31.8 11.895
Optimal vs High Vaulters
Optimal vs Low Vaulters
Variable Sensitivity(%)
Specificity(%)
Cut-Off Value
WTW 85.1 22.2 11.65
ACD 81.6 44.4 3.125
ACV 80.5 30 188.5
WTW: White-to-white(mm), STS: Sulcus-to-Sulcus(mm), ATA: Angle-to-Angle(mm)
WTW: White-to-white(mm), ACD: Anterior Chamber Depth(mm), ACV: Anterior Chamber Volume(mm3)
Combination of Specificities: vs High Vaulters
WTW(>11.65)
ATA(>11.895)
STS(>11.56)
90%
(Sensitivity > 80%)
Frequency Proportion Analysis
88.4% 83.6%
86.7%
(WTW, STS and ATA; all in mm)
Combination of Specificities: vs Low Vaulters
WTW(>11.65)
ACV(>188.5)ACD(>3.13)
93.4%
92.5% 91%
94.2%
Frequency Proportion Analysis(WTW, ACD and ACV; mm and mm3)
(Sensitivity > 80%)
VS Manufacturer Rec-ommendations
(#Manufacturer Recommendations for All ICLs that were Finally Implanted with 120 Sized S4 ICL)
Recommenda-tion#
Low Vault
Optimal Vault
High Vault
%
115 1 21 1 19.0
120 9 26 14 40.5
125 0 39 9 39.7
130 0 1 0 0.8
CONCLUSIONS1. Age, ACD, ACV and WTW were significant factors in predicting Post-op Low Vaulters.
A Combination of these Factors Raised Predictability to 93.4%.
2. STS, ATA and WTW were Significant Factors in Predicting Post-op High Vaulters. A Combination of these Factors Raised Predictability to 90%.
3.Current Paradigm of Relying on ACD, WTW and STS may need to be Revised in Asian Eyes.
4. Manufacturer Guidelines cannot be Infallible in Predicting Ideal Vaulting, especially In Asian Eyes.
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