DOI: 10.1097/j.jcrs.0000000000001593 ISSN: 0886-3350

Anterior Segment Pharmacological Accommodative Changes and Its Impact on the Circumferential Anterior Chamber Angle after ICL V4c Implantation

Shengtao Liu, Mingrui Cheng, Fang Liu, Feng Lin, Yichen Xiao, Xiaoying Wang, Xingtao Zhou
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PURPOSE:

To investigate the pharmacological accommodative changes of the anterior segment and its impact on the circumferential anterior chamber angle (ACA) after implantable collamer lens (ICL) implantation using swept-source optical coherence tomography (SS-OCT).

SETTING:

Eye and ENT Hospital, Fudan University, Shanghai, CHINA.

DESIGN:

Prospective randomized contralateral eye study.

METHODS:

Eight men and 24 women (mean age, 28.2 ± 5.8 years; range, 19–42 years); 64 eyes were included at 3 months after ICL implantation. One eye per patient was randomly assigned to undergo tropicamide instillation (mydriasis group), and the contralateral eye underwent pilocarpine instillation (miosis group). SS-OCT examinations were performed before and after instillation to measure angle parameters. Trabecular-iris angle 500 (TIA500), angle opening distance 500 (AOD500), trabecular-iris space area (TISA500), angle opening distance circumference area 500 (AODA500), trabecular-iris circumference volume 500 (TICV500), and central vault (ICL to crystalline lens [ICL-L]) were evaluated.

RESULTS:

Relative to baseline levels, TIA500, AOD500, and TISA500 values all increased significantly in both groups (all P < 0.01). AODA500 and TICV500 values increased by 19.7% and 12.1%, respectively, in the mydriasis group (all P < 0.001), and these values similarly increased by 23.4% and 27.7%, respectively, in the miosis group (all P < 0.001). After instillation, the ICL-L decrease in the miosis group was significantly larger than that in the mydriasis group (P = 0.004). Mean AOD500, TISA500, and TICV500 in the miosis group were significantly larger than those in the mydriasis group (all P ≤ 0.036), especially at 8 and 10 o’clock (all P ≤ 0.014). Correlation analyses indicated that the increase in anterior chamber angle parameters was positively correlated with the change in ICL-L for both groups.

CONCLUSIONS:

Pilocarpine induced a more significant increase in ACA than tropicamide, because of different mechanism of anterior segment changes. We recommend circumferential meridian scan to assess angle status.

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