Long-term Efficacy and Safety of the Implantable Collamer Lens in Eyes With an Anterior Chamber Depth of 2.6 to 2.8 mm

Purpose: To investigate the long-term visual outcomes of the Implantable Collamer Lens (ICL) with a central hole (ICL V4c; STAAR Surgical) in eyes with an anterior chamber depth (ACD) of 2.6 to 2.8 mm. Methods: This retrospective, non-comparative, interventional case series included 41 eyes of 41 patients receiving ICL V4c implantation for myopia or myopic astigmatism that were observed for 7.76 ± 0.92 years (range: 6 to 10 years). Analyzed parameters included corrected distance visual acuity (CDVA) and uncorrected distance visual acuity, manifest refraction, endothelial cell density (ECD), intraocular pressure (IOP), lens parameters, angle opening distance at 500 μm (AOD500), trabecular–iris angle (TIA), iris curvature, and haptic position. Results: At the final follow-up visit, the mean vault was 234.66 ± 131.63 μm (range: 26 to 574 μm) and 35 eyes (85.4%) had two or more haptics not located in the ciliary sulcus. The safety index was 1.20 ± 0.31 (range: 1.00 to 2.80); no eyes lost CDVA. The efficacy index was 0.85 ± 0.27 (range: 0.24 to 1.40). No pupillary block or IOP elevation requiring medication was observed. Peripheral anterior subcapsular cataract developed in three eyes (7.31%). ECD decreased by 9.39% (annual loss 30.24 ± 51.35 cells/mm 2 ). AOD500 and TIA decreased by 24.11% and 27.43%, respectively, with no angle closure observed on ultrasound biomicroscopy. Conclusions: ICL implantation in eyes with an ACD of 2.6 to 2.8 mm demonstrated acceptable long-term viability, provided that rigorous endothelial monitoring is maintained.