Determining vault size in implantable collamer lenses: Preoperative anatomy and lens parameters

Purpose: To determine patient preoperative anatomical features and the parameters of implantable collamer lenses (ICLs) relevant in explaining vault variability.Setting: Ophthalmology Clinic Vista Sanchez Trancon, Badajoz, Spain.Design: Retrospective case series.Methods: This study comprised 360 eyes of 360 patients implanted with myopic or toric ICLs. Pentacam imaging was used for assessing white-to-white (WTW) diameter, central keratometry, and central corneal thickness. Anterior-segment optical coherence tomography was used to measure the horizontal anterior chamber angle distance (ATA), internal anterior chamber (ACQ), crystalline lens rise (CLR), anterior chamber angle (ACA), and vault. The sample was divided according to the implanted lens size (12.6 mm, 13.2 mm, and 13.7 mm). Vault predictors were identified from the variables above using multivariate regression analysis.Results: The groups showed significant statistical differences for WTW, ATA, ACQ, ACA, and vault (P < .007 for all). In general, bigger lenses were implanted in eyes with larger transverse sizes (WTW and ATA) and deeper ACQ. Also, larger ICL diameters were associated with higher vaults. Multivariate regression analysis identified the lens size (13.2 mm as reference; 12.6 mm: beta [standardized coefficients] = -0.33; 13.7 mm: beta = 0.42), ATA (beta = -0.42), and CLR (beta = -0.25), ICL spherical equivalent (beta = -0.22) and patient age (beta = -0.12) as predictors of the vault size (adjusted-R-2 = 0.34 P < .001).Conclusions: The multivariate model explained 34% of vault variability. The predictors indicated the presence of different mechanisms regulating the vault. These involved the difference between the transverse size of the eye and the ICL, the crystalline lens protrusion, and the ICL properties, such as power and size. Copyright (C) 2020 Published by Wolters Kluwer on behalf of ASCRS and ESCRS.Manuscript Draf