Pearls for Getting Started with the Visian ICL

Neil J. Friedman, M.D.

About Author

Visian ICL

• Posterior chamber phakic IOL: FDA approved 2005
• Material: collamer (collagen copolymer); excellent biocompatibility and long-term stability
• Powers: -3 to -16 D for correction of myopia of -3 to -15 D and reduction of myopia of -15 to -20 D
• Plate haptic design: optic diameter (5.8 to 4.9 mm) and overall length (12.1 to 13.7 mm)

Patient Selection

• Age 21 to 45 years old
• Myopia of -3 to -20 D
• Anterior chamber depth (ACD) of ≥3 mm
• Normal endothelial cell count (ECC)
• Open angles (grade >2)
• Good dilation (≥8 mm)
• Astigmatism: toric version (outside US) or treat with LASIK/PRK/AI/LRI (US)

ICL Calculations

• Accurate measurements:
• Refraction (manifest and cylcoplegic)
• Vertex distance (very important)
• ACD (Visante OCT, IOLMaster, Pentacam, A-scan)
• White-to-white (calipers, Visante OCT, IOLMaster) or sulcus diameter (UBM)
• Online STAAR calculator
• Astigmatism correction: obtain preoperative topography and pachymetry to determine suitability and best surgical method

Peripheral Iridotomy

• Laser: 2 PIs superiorly, 3 clock hours apart (i.e., at 10:30 and 1:30 positions); should be performed at least 1 week prior to ICL procedure
• Surgical: 1 PI superiorly at end of ICL procedure
• ICL V4c with CentraFLOW does not require PI (only available outside US)

Surgical Technique

• Loading ICL: make sure there is some OVD on top of ICL so that it can easily be pulled down the cartridge barrel
• Side port incisions: place approximately 90 degrees from main incision to manipulate distal footplates
• OVD: use Ocucoat; do not overfill; place some above ICL prior to positioning footplates; remove with bimanual I/A or flushing with BSS
• Main incision: to manipulate proximal footplates, make long enough tunnel to prevent iris prolapse when flushing OVD with BSS
• Inject ICL slowly to ensure proper unfolding and orientation
• Do not touch or cross over central optic with intraocular instruments

Postop Check

• Perform approximately 2 hours after ICL implantation
• Critical to measure IOP, ICL vault (0.5-1.5 corneal thickness), and PI patency
• Most common reason for elevated IOP is pupillary block. Usually due to occluded or nonpatent PI or retained OVD rather than oversized ICL (distinguish by dilating pupil beyond edge of ICL).