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Intraoperative adjustment of implantable collamer lens vault by lens rotation aided by intraoperative OCT

ICL rotation from horizontal to vertical meridian significantly reduces vault. Intraoperative adjustment of ICL vault using an intraoperative OCT helps avoiding postsurgical vault-related complications. Purpose: To assess the use of intraoperative optical coherence tomography (OCT) to detect high vault during implantation surgery and guide intraoperative vault adjustment by implantable collamer lens (ICL) rotation. Setting: Instituto Zaldivar SA. Mendoza, Argentina. Design: Prospective single-arm observational study. Methods: 25 eyes of 25 consecutive patients showing high intraoperative vault who had undergone ICL rotation from horizontal to vertical or oblique position were evaluated. Central ICL vault was measured both intraoperatively using the microscope-integrated iOCT mounted on a standard surgical microscope (HS Hi-R NEO 900A NIR) and postoperatively using the Casia 2 swept-source OCT at 4 hours, 1 day, and 1 month. Results: 25 eyes of 25 consecutive patients showing high intraoperative vault who had undergone ICL rotation from horizontal to vertical or oblique position were evaluated. The mean vault value obtained intraoperatively was 1147.88 ± 188.36 μm and changed significantly to 739.76 ± 194.97 μm after lens rotation to either vertical (n = 19, 76% of cases) or oblique (n = 6, 24% of cases) positions (mean difference 408.12 ± 213.57 μm, P < .001). The amount of change due to lens rotation was significantly correlated with white-to-white distance (r = −0.480, P = .015) and vault before rotation (r = −0.564, P = .003). The mean vault values were 758.40 ± 187.10 μm, 729.73 ± 227.86 μm, and 661.88 ± 275.17 μm at 4 hours, 24 hours, and 1 month postsurgery, respectively. Conclusions: Intraoperative adjustment of ICL vault by lens rotation using intraoperative OCT was an effective procedure to obtain an optimal vault.