Correlation between vaulting intraoperative and postoperative of EVO implantable Collamer lens: a retrospective study of real-time observations of vaulting using the RESCAN 700 system

Correlation between vaulting intraoperative and postoperative of EVO implantable Collamer lens: a retrospective study of real-time observations of vaulting using the RESCAN 700 system | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Correlation between vaulting intraoperative and postoperative of EVO implantable Collamer lens: a retrospective study of real-time observations of vaulting using the RESCAN 700 system Nian Guan, Xiao-Nong Zhang, Wan-Jun Zhang This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-123289/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 03 Jan, 2022 Read the published version in BMC Ophthalmology → Version 1 posted 10 You are reading this latest preprint version Abstract Background: The prediction of implantable Collamer lens (ICL) vaulting is one of the most important parameters for ICL implantation for safety, aqueous humor circulation, and lens transparency. Methods: This was a retrospective study. A RESCAN 700 was used for intraoperative observation of vaulting. Spectral-domain optical coherence tomography was used for imaging. Results: Finally, 51 patients (102 eyes) were included in the study. Compared with the eyes with normal vaulting, those with high vaulting had higher preoperative diopter values (P=0.039), lower preoperative corrected visual acuity (P=0.006), lower preoperative intraocular pressure (P=0.029), higher preoperative anterior chamber depth (P=0.004), lower preoperative crystalline lens rise (P=0.046), higher ICL spherical equivalent (P=0.030), higher intraoperative vaulting (P<0.001), and lower intraocular pressure at 1 month (P=0.045). The multivariable analysis showed that the only factors independently associated with high vaulting at 1 month after surgery was the intraoperative vaulting value (odds ratio=1.005, 95% confidence interval: 1.002-1.007, P<0.001). The intraoperative and 1-month postoperative vaulting values were correlated (R 2 =0.562). Conclusions: The RESCAN700 system can be used to perform intraoperative optical coherence tomography to predict the vaulting value at 1 month. Ophthalmology lenses intraocular lens implantation intraocular tomography optical coherence refractive surgery post-operative vault. Figures Figure 1 Figure 2 Figure 3 Background Refractive errors of the eye are common conditions and include myopia (worldwide prevalence of 1.45 billion [ 1 ]), hyperopia (worldwide prevalence of 30.9% in adults [ 2 ]), and astigmatism (worldwide prevalence of 40.4% in adults [ 2 ]). Those errors arise when the images are not clearly focused on the retina due to the eyeball length and shape of the cornea. Corrective glasses or contact lenses are the most common methods used to achieve better vision. Implantable Collamer lens (ICL) is another option for the correction of refractive errors. The Visian ICL™ (STAAR Surgical, Nidau, Switzerland) is a posterior chamber phakic intraocular lens (IOL) [ 3 – 5 ]. The EVO-ICL is based on an artificial hole and achieves acceptable safety [ 6 ], and is similar to traditional ICLs in terms of high-order aberrations and contrast sensitivity [ 7 ]. Nevertheless, the most challenging parameter in ICL implantation is the accurate prediction of vaulting, and precise and optimal vaulting is the key parameter for successful ICL implantation [ 8 ]. An improper vaulting can lead to adverse events such as pupillary block, iris touch, angle-closure glaucoma, anterior lens opacification, and early cataract [ 9 – 11 ]. About 2.6% of implanted ICL have improper vaulting and require exchange [ 12 – 16 ]. Previous methods for determining vaulting involved white-to-white measurement (manually or with imaging systems) or sulcus-to-sulcus measurement using high-frequency ultrasound have been the main methods for vaulting prediction [ 17 , 18 ]. Later, optical coherence tomography (OCT) was added to refine the prediction [ 19 – 21 ]. Recent OCT systems that are built within the operating microscope now allow for more precise eye surgeries [ 22 – 24 ]. Only a few studies examined the use of intraoperative OCT for the determination of ICL vaulting [ 25 ]. Of note, a recent multivariable model explains only 34% of the variability of lens vaulting among individuals [ 26 ]. Hence, additional studies are necessary to refine the prediction of ICL vaulting. This study aimed to explore the factors associated with the actual vaulting after refractive EVO-ICL surgery and the correlation between intraoperative vaulting and the actual vaulting at 1 month after surgery, in order to determine whether OCT device during surgery could provide some clinical help. The results might help a better prediction of ICL vaulting and avoid the need for early ICL exchange. Methods Study design and patients This was a retrospective study of patients who underwent EVO-ICL surgery at Wuhan Bright Eye Hospital between October and December 2019. This study was approved by the Ethics Committee of this Hospital. The written informed consent was obtained from all patients. The inclusion criteria were: 1) age: 21–45 years; 2) anterior chamber depth (ACD) > 2.8 mm; 3) corneal endothelial cell density (ECD) > 2000/mm²; and 4) completed EVO-ICL surgery and follow-up in this hospital. The exclusion criteria were: 1) other eye diseases such as cataracts and glaucoma that caused visual loss; 2) systemic diseases such as diabetes, autoimmune diseases, or collagen diseases that could affect postoperative healing; or 3) being unable to measure vaulting due to unclear intraoperative OCT images. Preoperative Measurement The preoperative diopter, corrected visual acuity (CVA), white-to-white distance (WTW), IOP, ACD, anterior chamber volume (ACV), crystalline lens rise (CLR), axial length, and ECD were recorded. During surgery, the RESCAN 700 system (Carl Zeiss GmbH, Oberkochen, Germany) was used to measure EVO-ICL vaulting. Uncorrected visual acuity (UCVA) and best-corrected visual acuity (BCVA) were checked using an international standard visual acuity chart (converted into logMAR visual acuity). Subjective and objective refractions were performed using a CV-5000 comprehensive refractometer (Topcon Corporation, Tokyo, Japan). The anterior ocular segment was determined using an SL-115 Classic slit lamp microscope (Carl Zeiss GmbH, Oberkochen, Germany). A Pentacam HR three-dimensional panoramic analyzer for the anterior segment (Oculus, Wetzlar, Germany) was used to check corneal morphology, ACV, CLR, and WTW. A CT-800 non-contact tonometer (Topcon Corporation, Tokyo, Japan) was used to measure IOP. An IOL Master 700 biometer (Carl Zeiss GmbH, Oberkochen, Germany) was used to measure ACD and axial length. An SP-3000P corneal endothelial cell counter (Topcon Corporation, Tokyo, Japan) was used to measure corneal ECD. Fundoscopy was performed using a V90C non-contact slit lamp pre-set lens (Halma plc, Amersham, UK). Intraoperative vaulting was observed by using a RESCAN700 microscope (Carl Zeiss GmbH, Oberkochen, Germany). SD-OCT was used for scan imaging, and the ImageJ software was used to measure the ICL vault value. A CIRRUS HD-OCT (Carl Zeiss GmbH, Oberkochen, Germany) was used to measure the distance between the posterior surface of the EVO-ICL and the anterior lens capsule, namely the vault value. All measurements were performed by an ophthalmologist with 9 years of professional experience. EVO-ICL Surgery All procedures were performed by the same ophthalmologist with 4 years of professional experience. The size of the EVO-ICL was determined based on WTW, ACD, ACV, and CLR. The online system provided by the manufacturer was used to calculate the EVO-ICL diopter (STAAR Surgical Co., Monrovia, CA, USA). At 3 days before surgery, levofloxacin eye drops (Santen Pharmaceutical Co., Ltd., Osaka, Japan) were continuously administrated at 4 times/day. At 30 min before surgery, compound tropicamide eye drops (Santen Pharmaceutical Co., Ltd., Osaka, Japan) were used for mydriasis. Oxybuprocaine hydrochloride eye drops (Santen Pharmaceutical Co., Ltd., Osaka, Japan) were used to perform surface anesthesia. The axis of corneal astigmatism was marked under the slit lamp before surgery. Conventional disinfection and draping were conducted. The conjunctival sac was washed. The main incision was made at the steepest meridian of the cornea. A syringe was used to inject the EVO-ICL into the anterior chamber. An appropriate amount of 15 mg/ml medical sodium hyaluronate gel (Hangzhou Singclean Medical Products Co., Ltd., Hangzhou, China) was injected above the EVO-ICL to maintain the ACD. The four angles of the EVO-ICL were adjusted to the ciliary sulcus behind the iris with the adjustment hook, and the EVO-ICL was adjusted to the marked area and the residual viscoelastic in the anterior chamber. An Icare rebound tonometer (Icare Finland Oy, Vantaa, Finland) was used to measure the IOP, which was controlled at 15–18 mmHg by replenishing and releasing aqueous humor. A RESCAN 700 microscope (Carl Zeiss AG, Oberkochen, Germany) was used to perform the SD-OCT scan imaging. The five-line scanning mode was used, with a scanning depth of 2.0 mm and a scanning length of 2.0 mm. The distance between the posterior surface of EVO-ICL and anterior lens capsule was observed, and the snapshot mode was used to save the screenshot after clearing. After the end of the surgery, tobramycin dexamethasone eye drops (Alcon-Couvreur SA, Puurs, Belgium) were used. Intraoperative Measurement Of Vaulting A RESCAN 700 (Carl Zeiss AG, Oberkochen, Germany) was used for intraoperative imaging, and SD-OCT was used for scanning imaging. For intraoperative SD-OCT image export, the ImageJ software (version 1.48) was used for processing, and the scanning depth was adjusted to 2.0 mm. The distance between the posterior surface of EVO-ICL and anterior lens capsule was measured. All measurements were conducted three times, and the average values were recorded, namely the intraoperative vaulting values. Follow-up All patients were followed routinely at 1 month after surgery. The distance between the posterior surface of the EVO-ICL and anterior lens capsule (namely, the vaulting value) was measured using a CIRRUS HD-OCT (Carl Zeiss AG, Oberkochen, Germany). Under the same indoor light, all measurements were performed by the same ophthalmologist three times, and the average values were recorded. For the vault at 1 month after surgery, 250–750 µm was defined as normal vaulting, 750 µm as high vaulting [ 27 , 28 ]. At the same time, visual acuity, IOP, and diopter were measured. Statistical analysis SPSS 22.0 (IBM Corp., Armonk, NY, USA) was used for data processing and statistical analyses. Normally distributed continuous data (according to the Kolmogorov-Smirnov test) were presented as means ± standard deviations and analyzed using Student’s t-test. Non-normally distributed data were presented as medians (ranges) and analyzed using the Mann-Whitney U-test. Categorical data were presented as frequencies (percentage) and analyzed using the chi-square test or Fisher’s exact test. For the multivariable analysis, high vaulting at 1 month after surgery was used as the dependent variable, and the factors with between-group differences (P < 0.05) in the univariable analyses (enter method) were used as the independent variables. Binary logistic regression analysis was performed. Linear correlation analysis was performed regarding the intraoperative and postoperative vaulting. Two-sided (except for the chi-square test) P-values < 0.05 were considered statistically significant. Results Characteristics of the patients A total of 56 patients with 112 eyes were enrolled. Among them, vaulting could not be measured in five patients (10 eyes) by intraoperative OCT. Finally, 51 patients (102 eyes) were included in the study (Fig. 1 ). There were two (2.0%) eyes with low vaulting postoperatively, and two (2.0%) eyes underwent lens exchange due to high vaulting. Figure 2 presents typical vaulting measurements. Given there were only two patients with low vaulting, this study analyzed patients with normal vaulting and those with high vaulting. Table 1 presents the characteristics of the patients. Compared with the eyes with normal vaulting, those with high vaulting had higher preoperative diopter values (P = 0.039), lower preoperative CVA (P = 0.006), lower preoperative IOP (P = 0.029), higher preoperative ACD (P = 0.004), lower preoperative CLR (P = 0.046), higher ICL spherical equivalent (SE) (P = 0.030), higher intraoperative vaulting (P < 0.001), and lower IOP at 1 month (P = 0.045). Table 1 Characteristics of the patients Characteristics All (n = 100) Normal vaulting (n = 67) High vaulting (n = 33) P Sex (male), n (%) 35 (35) 26 (38.8) 9 (27.3) 0.256 Age (years), median (range) 25.5 (21,40) 26 (21,40) 25 (21,39) 0.680 Preoperative diopter SE (D), median (range) -8.5 (-18,-2.8) -8.4 (-18,-2.8) -8.8 (-18,-5) 0.039 Preoperative CVA (LogMar), median (range) 0 (0,0.5) 0 (0,0.5) 0 (0,0.4) 0.006 Preoperative IOP (mmHg), median (range) 18 (13,22) 19 (13,22) 17 (14,21) 0.029 Preoperative ACD (mm), median (range) 3.2 (2.8,3.7) 3.1 (2.8,3.7) 3.4 (2.8,3.7) 0.004 Preoperative ACV (µL), median (range) 205 (128,562) 204 (131,562) 217 (128,307) 0.172 Preoperative axial length (mm), mean ± SD 26.8 ± 1.3 26.7 ± 1.3 27.1 ± 1.1 0.080 Preoperative corneal ECD, mean ± SD 2914.1 ± 233.7 2910.3 ± 263.2 2922 ± 161.2 0.785 Preoperative WTW (mm), median (range) 11.7 (10.7,12.6) 11.6 (10.7,12.5) 11.8 (10.8,12.6) 0.091 Preoperative CLR (µm), median (range) 210 (0,520) 230 (0,520) 190 (0,390) 0.046 ICL size (mm), n (%) 0.175 121 4 (4) 3 (4.5) 1 (3) 126 38 (38) 30 (44.8) 8 (24.2) 132 52 (52) 30 (44.8) 22 (66.7) 137 6 (6) 4 (6) 2 (6.1) ICL degree SE (D), median (range) -9.5 (-18,-3.5) -9.5 (-18,-3.5) -10 (-18,-5.5) 0.030 Intraoperative vaulting (µm), mean ± SD 770.7 ± 323.5 657.2 ± 279.3 1001.2 ± 284.8 < 0.001 Vaulting at 1 month after surgery (µm), median (range) 634 (252,1650) 560 (252,730) 910 (760,1650) < 0.001 Visual acuity at 1 month after surgery (LogMar), median (range) -0.1 (-0.2,0.4) -0.1 (-0.2,0.4) -0.1 (-0.2,0.2) 0.284 Diopter SE at 1 month after surgery (D), median (range) 0.3 (-1.5,1.3) 0.3 (-1.5,1.3) 0.3 (-0.3,1) 0.127 IOP (mmHg) at 1 month after surgery, median (range) 18 (13,23) 18 (13,23) 17 (14,21) 0.045 Spherical equivalent = sphere power plus 1/2 cylinder power SE: spherical equivalent; CVA: corrected visual acuity; IOP: intraocular pressure; ACD: Anterior chamber depth; ACV: anterior chamber volume: ECD: Endothelial cell density; WTW: White-to-white distance; CLR: crystalline lens rise. Multivariable Analysis Based on the univariable analyses, preoperative diopter, preoperative CVA, preoperative IOP, preoperative ACD, preoperative CLR, ICL degree SE, and intraoperative vaulting were entered in the multivariable analysis (Table 2 ). The multivariable analysis showed that the only factors independently associated with high vaulting at 1 month after surgery was the intraoperative vaulting value (Table 2 ). Table 2 Independent influencing factors of high vaulting at 1 month after the operation Characteristics Univariable analysis Multivariable analysis OR 95%CI P OR 95%CI P Sex (male) 0.591 0.238,1.469 0.258 Age (years) 0.976 0.889,1.071 0.602 Preoperative diopter SE (D) 0.846 0.73,0.982 0.028 1.038 0.18,5.985 0.966 Preoperative CVA (LogMar) 210.273 1.444,30626.133 0.035 1.374 0.001,3409.882 0.937 Preoperative IOP (mmHg) 0.825 0.683,0.998 0.048 0.849 0.659,1.093 0.205 Preoperative ACD (mm) 12.695 1.999,80.604 0.007 5.955 0.415,85.456 0.189 Preoperative ACV (µL) 1.002 0.993,1.011 0.673 Preoperative axial length (mm) 1.362 0.96,1.933 0.084 Preoperative corneal ECD 1.000 0.998,1.002 0.813 Preoperative WTW (mm) 2.050 0.741,5.674 0.167 Preoperative CLR (µm) 0.996 0.992,0.999 0.022 0.997 0.992,1.002 0.274 ICL size(mm) 121 Ref Ref 126 0.800 0.073,8.764 0.855 132 2.200 0.214,22.591 0.507 137 1.500 0.089,25.392 0.779 ICL degree SE (D) 0.837 0.718,0.975 0.023 0.730 0.129,4.138 0.723 Intraoperative vault (µm) 1.004 1.002,1.006 < 0.001 1.005 1.002,1.007 < 0.001 OR: odds ratio; CI: confidence interval; SE: spherical equivalent; CVA: corrected visual acuity; IOP: intraocular pressure; ACD: Anterior chamber depth; ACV: anterior chamber volume: ECD: Endothelial cell density; WTW: White-to-white distance; CLR: crystalline lens rise. Correlation Analysis The results of the linear correlation analysis of intraoperative and postoperative vaulting are shown in Fig. 3 . The correlation was significant (R 2 = 0.562). Discussion The prediction of ICL vaulting is one of the most important parameters for ICL implantation. This study aimed to explore the factors associated with actual vaulting after EVO-ICL implantation and the correlation between intraoperative and 1-month vaulting using OCT. The results strongly suggest that the RESCAN700 system can be used to perform intraoperative OCT to predict the vaulting value at 1 month. Taking into account the correlation between intraoperative and 1-month vaulting, optimization interventions can be carried out in time to obtain better results when abnormal intraoperative vaulting was observed. The RESCAN 700 is the latest generation of operating microscopes integrating the LUEMRA microscope platform and OCT. It can be used to perform real-time observations of OCT images during surgery. Currently, studies reported the use of the RESCAN 700 system in vitreoretinal surgery, corneal transplantation, and cataract surgery [ 29 – 33 ]. Only one recent study used the RESCAN 700 to examine the vaulting after ICL implantation [ 25 ]. The accuracy of real-time intraoperative measurement of vaulting is critical to operation success. Indeed, the implantation of an ICL with the correct vaulting from the start will avoid complications (mechanical contact with the lens, pupillary block, iris touch, angle-closure glaucoma, anterior lens opacification, and early cataract [ 9 – 11 ]) and the need for reoperation and lens exchange [ 34 ]. This will save healthcare resources and money. The traditional methods to determine vaulting based on WTW and ACD lead to about 20% of the patients being outside the accepted vaulting range [ 35 , 36 ]. The STS can also be used, but the relationship between the WTW and STS is affected by the degree of myopia [ 37 – 42 ]. OCT is a valuable tool for predicting vaulting [ 19 – 21 , 25 ]. In the present study, two eyes had too high vaulting, and two eyes had too low vaulting, leading to 4% of the eyes being outside the appropriate vaulting range. In addition, a 90-µm was observed between the intraoperative and the 1-month values, similar to the 100-µm difference observed by Torbey et al. [ 25 ]. This difference is likely due to the surgery itself, the use of irrigation, intraoperative adjustment in IOP, and the use of drugs to dilate the pupil, while the OCT at 1-month was measured on a physiological pupil. Indeed, vaulting is affected by pupil size [ 43 ]. Despite this difference, the intraoperative and 1-month vaulting values were highly correlated, as supported by Torbey et al. [ 25 ]. On the other hand, a study showed only a 7-µm difference between the intraoperative and 3-month vaulting values [ 44 ]. The wide-angle OCT image acquisition is associated with image distortion and could be a source of bias. In addition, this previous study [ 44 ] did not mention if a miotic agent was used before measurement. Because of this difference in vaulting, it is difficult to determine whether an ICL should be exchanged when observing limit values. Nevertheless, as suggested by Torbey et al. [ 25 ], the ICL should be exchanged within the same operative session in the presence of extreme vaulting values, improving safety and patient satisfaction. Trancon et al. [ 26 ] elaborated a multivariable model that could predict vaulting and explain 34% of its variance; lens diameter, horizontal anterior chamber angle distance, CLR, ICL spherical equivalent, and patient age were independently associated with vaulting. In the present study, only the intraoperative vaulting was associated with the value at 1 month. This discrepancy could be due to the number of eyes, different OCT systems, and different drugs used for the eyes. Two eyes had ICL with too high vaulting and the ICL had to be exchanged in order to prevent short- and long-term complications like pupillary block, iris touch, angle-closure glaucoma, anterior lens opacification, and early cataract [ 9 – 11 ]. The rate of 2% reported here is within the numbers reported by the literature [ 12 – 16 ]. The two eyes with low vaulting were not reoperated, but closer follow-up was performed. The low vaulting observed in two eyes might be due to the smaller pupil diameters, as shown by a previous study [ 45 ]. This study has limitations. The study was performed at a single hospital, and the number of included eyes was small. Because of the retrospective nature of the study, only the routine follow-up at 1 month was available, and the changes in vaulting over time could not be examined. Future studies should include more patients and should be prospectively conducted in order to include more follow-up time points and longer follow-up. Conclusion The RESCAN700 system can be used to perform intraoperative OCT to predict the vaulting value at 1 month. Therefore, the vaulting observed during surgery is probably predictive of the actual value that will be achieved, allowing optimization interventions to be carried out over abnormal intraoperative vaulting in time to obtain better results. List Of Abbreviations ACD anterior chamber depth ACV anterior chamber volume AS-OCT anterior segment optical coherence tomography BCVA best-corrected visual acuity CLR crystalline lens rise CVA corrected visual acuity ECD endothelial cell density ICL implantable Collamer lens IOL intraocular lens OCT optical coherence tomography SE spherical equivalent UCVA uncorrected visual acuity WTW white-to-white distance Declarations Ethics approval and consent to participate Consent for publication Not applicable. Availability of data and materials The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Competing Interests All authors declare that they have no competing interests. Funding This study received no specific funding. Authors' contributions NG and XN Z carried out the studies, XN Z drafted the manuscript and participated in analysis, or interpretation of data. WJ Z participated in its design. 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Ophthalmology. 2012; 119:272-7. Nam SW, Lim DH, Hyun J, Chung ES, Chung TY. Buffering zone of implantable Collamer lens sizing in V4c. BMC ophthalmology. 2017; 17:260. Oh J, Shin HH, Kim JH, Kim HM, Song JS. Direct measurement of the ciliary sulcus diameter by 35-megahertz ultrasound biomicroscopy. Ophthalmology. 2007; 114:1685-8. Reinstein DZ, Archer TJ, Silverman RH, Rondeau MJ, Coleman DJ. Correlation of anterior chamber angle and ciliary sulcus diameters with white-to-white corneal diameter in high myopes using artemis VHF digital ultrasound. Journal of refractive surgery. 2009; 25:185-94. Kawamorita T, Uozato H, Kamiya K, Shimizu K. Relationship between ciliary sulcus diameter and anterior chamber diameter and corneal diameter. Journal of cataract and refractive surgery. 2010; 36:617-24. Nemeth G, Hassan Z, Szalai E, Berta A, Modis L, Jr. Comparative analysis of white-to-white and angle-to-angle distance measurements with partial coherence interferometry and optical coherence tomography. Journal of cataract and refractive surgery. 2010; 36:1862-6. Gao J, Liao RF, Li N. Ciliary sulcus diameters at different anterior chamber depths in highly myopic eyes. Journal of cataract and refractive surgery. 2013; 39:1011-6. Biermann J, Bredow L, Boehringer D, Reinhard T. Evaluation of ciliary sulcus diameter using ultrasound biomicroscopy in emmetropic eyes and myopic eyes. Journal of cataract and refractive surgery. 2011; 37:1686-93. Lee H, Kang SY, Seo KY, Chung B, Choi JY, Kim KS, Kim TI. Dynamic vaulting changes in V4c versus V4 posterior chamber phakic lenses under differing lighting conditions. American journal of ophthalmology. 2014; 158:1199-204 e1. Titiyal JS, Kaur M, Sahu S, Sharma N, Sinha R. Real-time assessment of intraoperative vaulting in implantable collamer lens and correlation with postoperative vaulting. European journal of ophthalmology. 2017; 27:21-5. Lee H, Kang DSY, Choi JY, Ha BJ, Kim EK, Seo KY, Kim TI. Analysis of pre-operative factors affecting range of optimal vaulting after implantation of 12.6-mm V4c implantable collamer lens in myopic eyes. BMC ophthalmology. 2018; 18:163. Cite Share Download PDF Status: Published Journal Publication published 03 Jan, 2022 Read the published version in BMC Ophthalmology → Version 1 posted Editorial decision: Major revision 22 Feb, 2021 Reviews received at journal 18 Feb, 2021 Reviewers agreed at journal 02 Feb, 2021 Reviews received at journal 07 Jan, 2021 Reviewers agreed at journal 04 Jan, 2021 Reviewers invited by journal 04 Jan, 2021 Editor assigned by journal 04 Jan, 2021 Editor invited by journal 28 Dec, 2020 Submission checks completed at journal 28 Dec, 2020 First submitted to journal 07 Dec, 2020 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-123289","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":7184891,"identity":"979fd014-78a8-4cf0-91cd-a1058a860973","order_by":0,"name":"Nian Guan","email":"","orcid":"","institution":"Wuhan Bright Eye Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Nian","middleName":"","lastName":"Guan","suffix":""},{"id":7184892,"identity":"f7367012-dca2-45e7-8b91-e35f4f8f3933","order_by":1,"name":"Xiao-Nong Zhang","email":"","orcid":"","institution":"Wuhan Bright Eye Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Xiao-Nong","middleName":"","lastName":"Zhang","suffix":""},{"id":7184893,"identity":"15373152-83de-4879-80a3-6f8d9d7704da","order_by":2,"name":"Wan-Jun Zhang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAsElEQVRIiWNgGAWjYBACfvbmg49/VEjIEa9FsudYsjHDGRtj4rUY3PAxk2ZsSUtsIN6WGWzJxoUNh9P7jicwfviYQ4QWfmmgX2buOJw788wDZsmZ24ixZc6xZAPeM4dzN9xIYGPmJUaLwY0cMwnetsPpBiRpkeZtS0sgXgsokA1nnLExnHnmYTNxfgFF5YMPFRLyfMeTD374SIwWBDhAQtTAtCSQqmMUjIJRMApGCgAA3EQ/eXf83EUAAAAASUVORK5CYII=","orcid":"","institution":"Hefei Bright Eye Hospital","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Wan-Jun","middleName":"","lastName":"Zhang","suffix":""}],"badges":[],"createdAt":"2020-12-07 08:29:09","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-123289/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-123289/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12886-021-02237-2","type":"published","date":"2022-01-03T11:50:43+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":4586115,"identity":"01b12c56-9b17-4090-ae80-c06ce959efd3","added_by":"auto","created_at":"2020-12-29 21:33:17","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":63240,"visible":true,"origin":"","legend":"Patient flowchart.","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-123289/v1/568c3b29b8caa673e8359cae.png"},{"id":4586116,"identity":"ab2a00a6-873d-40c3-bfcb-a64bd4f28268","added_by":"auto","created_at":"2020-12-29 21:33:17","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":525095,"visible":true,"origin":"","legend":"Typical figures for measuring vaulting (intraoperative). (A) Low intraoperative vaulting; (B) Normal intraoperative vaulting; (C) High intraoperative vaulting.","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-123289/v1/7f7b6a483009b3bb53db910a.png"},{"id":4586002,"identity":"e1a0ca8f-c9d3-4ab7-8f92-ca2e540116d0","added_by":"auto","created_at":"2020-12-29 21:30:17","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":353373,"visible":true,"origin":"","legend":"Linear correlation between intraoperative vaulting and the vaulting at 1 month after surgery. X-axis: intraoperative vaulting. Y-axis: vaulting at 1 month after surgery.","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-123289/v1/db98ebd35c55582cbaa61b7a.png"},{"id":16930658,"identity":"4e5a0c2b-4bbb-4b7c-b886-3aff89104764","added_by":"auto","created_at":"2022-01-03 11:50:47","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1033569,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-123289/v1/2ddf86f4-410c-4d6e-8c89-f34e2ed9dd97.pdf"}],"financialInterests":"","formattedTitle":"Correlation between vaulting intraoperative and postoperative of EVO implantable Collamer lens: a retrospective study of real-time observations of vaulting using the RESCAN 700 system","fulltext":[{"header":"Background","content":"\u003cp\u003eRefractive errors of the eye are common conditions and include myopia (worldwide prevalence of 1.45\u0026nbsp;billion [\u003cspan class=\"CitationRef\"\u003e1\u003c/span\u003e]), hyperopia (worldwide prevalence of 30.9% in adults [\u003cspan class=\"CitationRef\"\u003e2\u003c/span\u003e]), and astigmatism (worldwide prevalence of 40.4% in adults [\u003cspan class=\"CitationRef\"\u003e2\u003c/span\u003e]). Those errors arise when the images are not clearly focused on the retina due to the eyeball length and shape of the cornea. Corrective glasses or contact lenses are the most common methods used to achieve better vision.\u003c/p\u003e\n\u003cp\u003eImplantable Collamer lens (ICL) is another option for the correction of refractive errors. The Visian ICL\u0026trade; (STAAR Surgical, Nidau, Switzerland) is a posterior chamber phakic intraocular lens (IOL) [\u003cspan class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e5\u003c/span\u003e]. The EVO-ICL is based on an artificial hole and achieves acceptable safety [\u003cspan class=\"CitationRef\"\u003e6\u003c/span\u003e], and is similar to traditional ICLs in terms of high-order aberrations and contrast sensitivity [\u003cspan class=\"CitationRef\"\u003e7\u003c/span\u003e]. Nevertheless, the most challenging parameter in ICL implantation is the accurate prediction of vaulting, and precise and optimal vaulting is the key parameter for successful ICL implantation [\u003cspan class=\"CitationRef\"\u003e8\u003c/span\u003e]. An improper vaulting can lead to adverse events such as pupillary block, iris touch, angle-closure glaucoma, anterior lens opacification, and early cataract [\u003cspan class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e11\u003c/span\u003e]. About 2.6% of implanted ICL have improper vaulting and require exchange [\u003cspan class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e\n\u003cp\u003ePrevious methods for determining vaulting involved white-to-white measurement (manually or with imaging systems) or sulcus-to-sulcus measurement using high-frequency ultrasound have been the main methods for vaulting prediction [\u003cspan class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e18\u003c/span\u003e]. Later, optical coherence tomography (OCT) was added to refine the prediction [\u003cspan class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e21\u003c/span\u003e]. Recent OCT systems that are built within the operating microscope now allow for more precise eye surgeries [\u003cspan class=\"CitationRef\"\u003e22\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e24\u003c/span\u003e]. Only a few studies examined the use of intraoperative OCT for the determination of ICL vaulting [\u003cspan class=\"CitationRef\"\u003e25\u003c/span\u003e]. Of note, a recent multivariable model explains only 34% of the variability of lens vaulting among individuals [\u003cspan class=\"CitationRef\"\u003e26\u003c/span\u003e]. Hence, additional studies are necessary to refine the prediction of ICL vaulting.\u003c/p\u003e\n\u003cp\u003eThis study aimed to explore the factors associated with the actual vaulting after refractive EVO-ICL surgery and the correlation between intraoperative vaulting and the actual vaulting at 1 month after surgery, in order to determine whether OCT device during surgery could provide some clinical help. The results might help a better prediction of ICL vaulting and avoid the need for early ICL exchange.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\n\u003cp\u003e\u003cstrong\u003eStudy design and patients\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis was a retrospective study of patients who underwent EVO-ICL surgery at Wuhan Bright Eye Hospital between October and December 2019. This study was approved by the Ethics Committee of this Hospital. The written informed consent was obtained from all patients.\u003c/p\u003e\n\u003cp\u003eThe inclusion criteria were: 1) age: 21\u0026ndash;45 years; 2) anterior chamber depth (ACD)\u0026thinsp;\u0026gt;\u0026thinsp;2.8\u0026nbsp;mm; 3) corneal endothelial cell density (ECD)\u0026thinsp;\u0026gt;\u0026thinsp;2000/mm\u0026sup2;; and 4) completed EVO-ICL surgery and follow-up in this hospital. The exclusion criteria were: 1) other eye diseases such as cataracts and glaucoma that caused visual loss; 2) systemic diseases such as diabetes, autoimmune diseases, or collagen diseases that could affect postoperative healing; or 3) being unable to measure vaulting due to unclear intraoperative OCT images.\u003c/p\u003e\n\u003c/div\u003e\u003cp\u003e\u003cstrong\u003ePreoperative Measurement\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eThe preoperative diopter, corrected visual acuity (CVA), white-to-white distance (WTW), IOP, ACD, anterior chamber volume (ACV), crystalline lens rise (CLR), axial length, and ECD were recorded. During surgery, the RESCAN 700 system (Carl Zeiss GmbH, Oberkochen, Germany) was used to measure EVO-ICL vaulting. Uncorrected visual acuity (UCVA) and best-corrected visual acuity (BCVA) were checked using an international standard visual acuity chart (converted into logMAR visual acuity).\u003c/p\u003e\n\u003cp\u003eSubjective and objective refractions were performed using a CV-5000 comprehensive refractometer (Topcon Corporation, Tokyo, Japan). The anterior ocular segment was determined using an SL-115 Classic slit lamp microscope (Carl Zeiss GmbH, Oberkochen, Germany). A Pentacam HR three-dimensional panoramic analyzer for the anterior segment (Oculus, Wetzlar, Germany) was used to check corneal morphology, ACV, CLR, and WTW. A CT-800 non-contact tonometer (Topcon Corporation, Tokyo, Japan) was used to measure IOP. An IOL Master 700 biometer (Carl Zeiss GmbH, Oberkochen, Germany) was used to measure ACD and axial length. An SP-3000P corneal endothelial cell counter (Topcon Corporation, Tokyo, Japan) was used to measure corneal ECD. Fundoscopy was performed using a V90C non-contact slit lamp pre-set lens (Halma plc, Amersham, UK). Intraoperative vaulting was observed by using a RESCAN700 microscope (Carl Zeiss GmbH, Oberkochen, Germany). SD-OCT was used for scan imaging, and the ImageJ software was used to measure the ICL vault value. A CIRRUS HD-OCT (Carl Zeiss GmbH, Oberkochen, Germany) was used to measure the distance between the posterior surface of the EVO-ICL and the anterior lens capsule, namely the vault value. All measurements were performed by an ophthalmologist with 9\u0026nbsp;years of professional experience.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eEVO-ICL Surgery\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eAll procedures were performed by the same ophthalmologist with 4\u0026nbsp;years of professional experience. The size of the EVO-ICL was determined based on WTW, ACD, ACV, and CLR. The online system provided by the manufacturer was used to calculate the EVO-ICL diopter (STAAR Surgical Co., Monrovia, CA, USA). At 3\u0026nbsp;days before surgery, levofloxacin eye drops (Santen Pharmaceutical Co., Ltd., Osaka, Japan) were continuously administrated at 4 times/day. At 30\u0026nbsp;min before surgery, compound tropicamide eye drops (Santen Pharmaceutical Co., Ltd., Osaka, Japan) were used for mydriasis. Oxybuprocaine hydrochloride eye drops (Santen Pharmaceutical Co., Ltd., Osaka, Japan) were used to perform surface anesthesia. The axis of corneal astigmatism was marked under the slit lamp before surgery. Conventional disinfection and draping were conducted. The conjunctival sac was washed. The main incision was made at the steepest meridian of the cornea. A syringe was used to inject the EVO-ICL into the anterior chamber. An appropriate amount of 15\u0026nbsp;mg/ml medical sodium hyaluronate gel (Hangzhou Singclean Medical Products Co., Ltd., Hangzhou, China) was injected above the EVO-ICL to maintain the ACD. The four angles of the EVO-ICL were adjusted to the ciliary sulcus behind the iris with the adjustment hook, and the EVO-ICL was adjusted to the marked area and the residual viscoelastic in the anterior chamber. An Icare rebound tonometer (Icare Finland Oy, Vantaa, Finland) was used to measure the IOP, which was controlled at 15\u0026ndash;18\u0026nbsp;mmHg by replenishing and releasing aqueous humor. A RESCAN 700 microscope (Carl Zeiss AG, Oberkochen, Germany) was used to perform the SD-OCT scan imaging. The five-line scanning mode was used, with a scanning depth of 2.0\u0026nbsp;mm and a scanning length of 2.0\u0026nbsp;mm. The distance between the posterior surface of EVO-ICL and anterior lens capsule was observed, and the snapshot mode was used to save the screenshot after clearing. After the end of the surgery, tobramycin dexamethasone eye drops (Alcon-Couvreur SA, Puurs, Belgium) were used.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eIntraoperative Measurement Of Vaulting\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eA RESCAN 700 (Carl Zeiss AG, Oberkochen, Germany) was used for intraoperative imaging, and SD-OCT was used for scanning imaging. For intraoperative SD-OCT image export, the ImageJ software (version 1.48) was used for processing, and the scanning depth was adjusted to 2.0\u0026nbsp;mm. The distance between the posterior surface of EVO-ICL and anterior lens capsule was measured. All measurements were conducted three times, and the average values were recorded, namely the intraoperative vaulting values.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eFollow-up\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eAll patients were followed routinely at 1 month after surgery. The distance between the posterior surface of the EVO-ICL and anterior lens capsule (namely, the vaulting value) was measured using a CIRRUS HD-OCT (Carl Zeiss AG, Oberkochen, Germany). Under the same indoor light, all measurements were performed by the same ophthalmologist three times, and the average values were recorded. For the vault at 1 month after surgery, 250\u0026ndash;750\u0026nbsp;\u0026micro;m was defined as normal vaulting, \u0026lt;\u0026thinsp;250\u0026nbsp;\u0026micro;m as low vaulting, and \u0026gt;\u0026thinsp;750\u0026nbsp;\u0026micro;m as high vaulting [\u003cspan class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e28\u003c/span\u003e]. At the same time, visual acuity, IOP, and diopter were measured.\u003c/p\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSPSS 22.0 (IBM Corp., Armonk, NY, USA) was used for data processing and statistical analyses. Normally distributed continuous data (according to the Kolmogorov-Smirnov test) were presented as means\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviations and analyzed using Student\u0026rsquo;s t-test. Non-normally distributed data were presented as medians (ranges) and analyzed using the Mann-Whitney U-test. Categorical data were presented as frequencies (percentage) and analyzed using the chi-square test or Fisher\u0026rsquo;s exact test. For the multivariable analysis, high vaulting at 1 month after surgery was used as the dependent variable, and the factors with between-group differences (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05) in the univariable analyses (enter method) were used as the independent variables. Binary logistic regression analysis was performed. Linear correlation analysis was performed regarding the intraoperative and postoperative vaulting. Two-sided (except for the chi-square test) P-values\u0026thinsp;\u0026lt;\u0026thinsp;0.05 were considered statistically significant.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\n\u003cp\u003e\u003cstrong\u003eCharacteristics of the patients\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 56 patients with 112 eyes were enrolled. Among them, vaulting could not be measured in five patients (10 eyes) by intraoperative OCT. Finally, 51 patients (102 eyes) were included in the study (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e). There were two (2.0%) eyes with low vaulting postoperatively, and two (2.0%) eyes underwent lens exchange due to high vaulting. Figure\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e presents typical vaulting measurements. Given there were only two patients with low vaulting, this study analyzed patients with normal vaulting and those with high vaulting.\u003c/p\u003e\n\u003cp\u003eTable\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e presents the characteristics of the patients. Compared with the eyes with normal vaulting, those with high vaulting had higher preoperative diopter values (P\u0026thinsp;=\u0026thinsp;0.039), lower preoperative CVA (P\u0026thinsp;=\u0026thinsp;0.006), lower preoperative IOP (P\u0026thinsp;=\u0026thinsp;0.029), higher preoperative ACD (P\u0026thinsp;=\u0026thinsp;0.004), lower preoperative CLR (P\u0026thinsp;=\u0026thinsp;0.046), higher ICL spherical equivalent (SE) (P\u0026thinsp;=\u0026thinsp;0.030), higher intraoperative vaulting (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and lower IOP at 1 month (P\u0026thinsp;=\u0026thinsp;0.045).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab1\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eCharacteristics of the patients\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eCharacteristics\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eAll (n\u0026thinsp;=\u0026thinsp;100)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eNormal vaulting (n\u0026thinsp;=\u0026thinsp;67)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eHigh vaulting (n\u0026thinsp;=\u0026thinsp;33)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eP\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSex (male), n (%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e35 (35)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e26 (38.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e9 (27.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.256\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAge (years), median (range)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e25.5 (21,40)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e26 (21,40)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e25 (21,39)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.680\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePreoperative diopter SE (D), median (range)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-8.5 (-18,-2.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-8.4 (-18,-2.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-8.8 (-18,-5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.039\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePreoperative CVA (LogMar), median (range)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0 (0,0.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0 (0,0.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0 (0,0.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.006\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePreoperative IOP (mmHg), median (range)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e18 (13,22)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e19 (13,22)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e17 (14,21)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.029\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePreoperative ACD (mm), median (range)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3.2 (2.8,3.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3.1 (2.8,3.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3.4 (2.8,3.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.004\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePreoperative ACV (\u0026micro;L), median (range)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e205 (128,562)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e204 (131,562)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e217 (128,307)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.172\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePreoperative axial length (mm), mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e26.8\u0026thinsp;\u0026plusmn;\u0026thinsp;1.3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e26.7\u0026thinsp;\u0026plusmn;\u0026thinsp;1.3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e27.1\u0026thinsp;\u0026plusmn;\u0026thinsp;1.1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.080\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePreoperative corneal ECD, mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2914.1\u0026thinsp;\u0026plusmn;\u0026thinsp;233.7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2910.3\u0026thinsp;\u0026plusmn;\u0026thinsp;263.2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2922\u0026thinsp;\u0026plusmn;\u0026thinsp;161.2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.785\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePreoperative WTW (mm), median (range)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e11.7 (10.7,12.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e11.6 (10.7,12.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e11.8 (10.8,12.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.091\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePreoperative CLR (\u0026micro;m), median (range)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e210 (0,520)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e230 (0,520)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e190 (0,390)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.046\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eICL size (mm), n (%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.175\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e121\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4 (4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3 (4.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1 (3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e126\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e38 (38)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e30 (44.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e8 (24.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e132\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e52 (52)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e30 (44.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e22 (66.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e137\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e6 (6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4 (6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2 (6.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eICL degree SE (D), median (range)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-9.5 (-18,-3.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-9.5 (-18,-3.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-10 (-18,-5.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.030\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eIntraoperative vaulting (\u0026micro;m), mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e770.7\u0026thinsp;\u0026plusmn;\u0026thinsp;323.5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e657.2\u0026thinsp;\u0026plusmn;\u0026thinsp;279.3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1001.2\u0026thinsp;\u0026plusmn;\u0026thinsp;284.8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eVaulting at 1 month after surgery (\u0026micro;m), median (range)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e634 (252,1650)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e560 (252,730)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e910 (760,1650)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eVisual acuity at 1 month after surgery (LogMar), median (range)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.1 (-0.2,0.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.1 (-0.2,0.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.1 (-0.2,0.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.284\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eDiopter SE at 1 month after surgery (D), median (range)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.3 (-1.5,1.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.3 (-1.5,1.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.3 (-0.3,1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.127\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eIOP (mmHg) at 1 month after surgery, median (range)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e18 (13,23)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e18 (13,23)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e17 (14,21)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.045\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003ctfoot\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"5\"\u003eSpherical equivalent\u0026thinsp;=\u0026thinsp;sphere power plus 1/2 cylinder power\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"5\"\u003eSE: spherical equivalent; CVA: corrected visual acuity; IOP: intraocular pressure; ACD: Anterior chamber depth; ACV: anterior chamber volume: ECD: Endothelial cell density; WTW: White-to-white distance; CLR: crystalline lens rise.\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tfoot\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/div\u003e\n\u003c/div\u003e\u003cp\u003e\u003cstrong\u003eMultivariable Analysis\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eBased on the univariable analyses, preoperative diopter, preoperative CVA, preoperative IOP, preoperative ACD, preoperative CLR, ICL degree SE, and intraoperative vaulting were entered in the multivariable analysis (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e). The multivariable analysis showed that the only factors independently associated with high vaulting at 1 month after surgery was the intraoperative vaulting value (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab2\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eIndependent influencing factors of high vaulting at 1 month after the operation\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eCharacteristics\u003c/p\u003e\n\u003c/th\u003e\n\u003cth colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003eUnivariable analysis\u003c/p\u003e\n\u003c/th\u003e\n\u003cth colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003eMultivariable analysis\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eOR\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e95%CI\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eP\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eOR\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e95%CI\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eP\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSex (male)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.591\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.238,1.469\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.258\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAge (years)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.976\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.889,1.071\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.602\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePreoperative diopter SE (D)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.846\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.73,0.982\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.028\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.038\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.18,5.985\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.966\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePreoperative CVA (LogMar)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e210.273\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.444,30626.133\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.035\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.374\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.001,3409.882\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.937\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePreoperative IOP (mmHg)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.825\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.683,0.998\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.048\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.849\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.659,1.093\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.205\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePreoperative ACD (mm)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e12.695\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.999,80.604\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.007\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5.955\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.415,85.456\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.189\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePreoperative ACV (\u0026micro;L)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.002\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.993,1.011\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.673\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePreoperative axial length (mm)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.362\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.96,1.933\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.084\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePreoperative corneal ECD\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.000\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.998,1.002\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.813\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePreoperative WTW (mm)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2.050\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.741,5.674\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.167\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePreoperative CLR (\u0026micro;m)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.996\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.992,0.999\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.022\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.997\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.992,1.002\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.274\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eICL size(mm)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e121\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRef\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRef\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e126\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.800\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.073,8.764\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.855\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e132\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2.200\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.214,22.591\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.507\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e137\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.500\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.089,25.392\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.779\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eICL degree SE (D)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.837\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.718,0.975\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.023\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.730\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.129,4.138\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.723\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eIntraoperative vault (\u0026micro;m)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.004\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.002,1.006\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.005\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.002,1.007\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003ctfoot\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"7\"\u003eOR: odds ratio; CI: confidence interval; SE: spherical equivalent; CVA: corrected visual acuity; IOP: intraocular pressure; ACD: Anterior chamber depth; ACV: anterior chamber volume: ECD: Endothelial cell density; WTW: White-to-white distance; CLR: crystalline lens rise.\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tfoot\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/div\u003e\u003cp\u003e\u003cstrong\u003eCorrelation Analysis\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eThe results of the linear correlation analysis of intraoperative and postoperative vaulting are shown in Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e. The correlation was significant (R\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.562).\u003c/p\u003e\n"},{"header":"Discussion","content":"\u003cp\u003eThe prediction of ICL vaulting is one of the most important parameters for ICL implantation. This study aimed to explore the factors associated with actual vaulting after EVO-ICL implantation and the correlation between intraoperative and 1-month vaulting using OCT. The results strongly suggest that the RESCAN700 system can be used to perform intraoperative OCT to predict the vaulting value at 1 month. Taking into account the correlation between intraoperative and 1-month vaulting, optimization interventions can be carried out in time to obtain better results when abnormal intraoperative vaulting was observed.\u003c/p\u003e\n\u003cp\u003eThe RESCAN 700 is the latest generation of operating microscopes integrating the LUEMRA microscope platform and OCT. It can be used to perform real-time observations of OCT images during surgery. Currently, studies reported the use of the RESCAN 700 system in vitreoretinal surgery, corneal transplantation, and cataract surgery [\u003cspan class=\"CitationRef\"\u003e29\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e33\u003c/span\u003e]. Only one recent study used the RESCAN 700 to examine the vaulting after ICL implantation [\u003cspan class=\"CitationRef\"\u003e25\u003c/span\u003e]. The accuracy of real-time intraoperative measurement of vaulting is critical to operation success. Indeed, the implantation of an ICL with the correct vaulting from the start will avoid complications (mechanical contact with the lens, pupillary block, iris touch, angle-closure glaucoma, anterior lens opacification, and early cataract [\u003cspan class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e11\u003c/span\u003e]) and the need for reoperation and lens exchange [\u003cspan class=\"CitationRef\"\u003e34\u003c/span\u003e]. This will save healthcare resources and money.\u003c/p\u003e\n\u003cp\u003eThe traditional methods to determine vaulting based on WTW and ACD lead to about 20% of the patients being outside the accepted vaulting range [\u003cspan class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e36\u003c/span\u003e]. The STS can also be used, but the relationship between the WTW and STS is affected by the degree of myopia [\u003cspan class=\"CitationRef\"\u003e37\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e42\u003c/span\u003e]. OCT is a valuable tool for predicting vaulting [\u003cspan class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e25\u003c/span\u003e]. In the present study, two eyes had too high vaulting, and two eyes had too low vaulting, leading to 4% of the eyes being outside the appropriate vaulting range. In addition, a 90-\u0026micro;m was observed between the intraoperative and the 1-month values, similar to the 100-\u0026micro;m difference observed by Torbey et al. [\u003cspan class=\"CitationRef\"\u003e25\u003c/span\u003e]. This difference is likely due to the surgery itself, the use of irrigation, intraoperative adjustment in IOP, and the use of drugs to dilate the pupil, while the OCT at 1-month was measured on a physiological pupil. Indeed, vaulting is affected by pupil size [\u003cspan class=\"CitationRef\"\u003e43\u003c/span\u003e]. Despite this difference, the intraoperative and 1-month vaulting values were highly correlated, as supported by Torbey et al. [\u003cspan class=\"CitationRef\"\u003e25\u003c/span\u003e]. On the other hand, a study showed only a 7-\u0026micro;m difference between the intraoperative and 3-month vaulting values [\u003cspan class=\"CitationRef\"\u003e44\u003c/span\u003e]. The wide-angle OCT image acquisition is associated with image distortion and could be a source of bias. In addition, this previous study [\u003cspan class=\"CitationRef\"\u003e44\u003c/span\u003e] did not mention if a miotic agent was used before measurement.\u003c/p\u003e\n\u003cp\u003eBecause of this difference in vaulting, it is difficult to determine whether an ICL should be exchanged when observing limit values. Nevertheless, as suggested by Torbey et al. [\u003cspan class=\"CitationRef\"\u003e25\u003c/span\u003e], the ICL should be exchanged within the same operative session in the presence of extreme vaulting values, improving safety and patient satisfaction. Trancon et al. [\u003cspan class=\"CitationRef\"\u003e26\u003c/span\u003e] elaborated a multivariable model that could predict vaulting and explain 34% of its variance; lens diameter, horizontal anterior chamber angle distance, CLR, ICL spherical equivalent, and patient age were independently associated with vaulting. In the present study, only the intraoperative vaulting was associated with the value at 1 month. This discrepancy could be due to the number of eyes, different OCT systems, and different drugs used for the eyes. Two eyes had ICL with too high vaulting and the ICL had to be exchanged in order to prevent short- and long-term complications like pupillary block, iris touch, angle-closure glaucoma, anterior lens opacification, and early cataract [\u003cspan class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e11\u003c/span\u003e]. The rate of 2% reported here is within the numbers reported by the literature [\u003cspan class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e16\u003c/span\u003e]. The two eyes with low vaulting were not reoperated, but closer follow-up was performed. The low vaulting observed in two eyes might be due to the smaller pupil diameters, as shown by a previous study [\u003cspan class=\"CitationRef\"\u003e45\u003c/span\u003e].\u003c/p\u003e\n\u003cp\u003eThis study has limitations. The study was performed at a single hospital, and the number of included eyes was small. Because of the retrospective nature of the study, only the routine follow-up at 1 month was available, and the changes in vaulting over time could not be examined. Future studies should include more patients and should be prospectively conducted in order to include more follow-up time points and longer follow-up.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe RESCAN700 system can be used to perform intraoperative OCT to predict the vaulting value at 1 month. Therefore, the vaulting observed during surgery is probably predictive of the actual value that will be achieved, allowing optimization interventions to be carried out over abnormal intraoperative vaulting in time to obtain better results.\u003c/p\u003e"},{"header":"List Of Abbreviations","content":"\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Taba\" border=\"1\"\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eACD\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eanterior chamber depth\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eACV\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eanterior chamber volume\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAS-OCT\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eanterior segment optical coherence tomography\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eBCVA\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ebest-corrected visual acuity\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCLR\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ecrystalline lens rise\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCVA\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ecorrected visual acuity\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eECD\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eendothelial cell density\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eICL\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eimplantable Collamer lens\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eIOL\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eintraocular lens\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eOCT\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eoptical coherence tomography\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSE\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003espherical equivalent\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eUCVA\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003euncorrected visual acuity\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eWTW\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ewhite-to-white distance\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study received no specific funding.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNG and XN Z carried out the studies, XN Z drafted the manuscript and participated in analysis, or interpretation of data. WJ Z participated in its design. NG and XN Z performed the statistical analysis. WJ Z participated in collecting data and acquisition. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to thank all study participants who were enrolled in this study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eHolden BA, Wilson DA, Jong M, Sankaridurg P, Fricke TR, Smith EL, III, Resnikoff S. Myopia: a growing global problem with sight-threatening complications. Community eye health. 2015; 28:35.\u003c/li\u003e\n\u003cli\u003eHashemi H, Fotouhi A, Yekta A, Pakzad R, Ostadimoghaddam H, Khabazkhoob M. Global and regional estimates of prevalence of refractive errors: Systematic review and meta-analysis. 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Comparison of intraoperative vs postoperative optical coherence tomography measurement of implantable collamer lens vaulting. Journal of cataract and refractive surgery. 2020; 46:737-41.\u003c/li\u003e\n\u003cli\u003eTrancon AS, Manito SC, Sierra OT, Baptista AM, Serra PM. Determining vault size in implantable collamer lenses: preoperative anatomy and lens parameters. Journal of cataract and refractive surgery. 2020; 46:728-36.\u003c/li\u003e\n\u003cli\u003eChoi KH, Chung SE, Chung TY, Chung ES. Ultrasound biomicroscopy for determining visian implantable contact lens length in phakic IOL implantation. Journal of refractive surgery. 2007; 23:362-7.\u003c/li\u003e\n\u003cli\u003eWang X, Zhou X. Update on Treating High Myopia With Implantable Collamer Lenses. Asia-Pacific journal of ophthalmology. 2016; 5:445-9.\u003c/li\u003e\n\u003cli\u003eKobayashi A, Yokogawa H, Mori N, Sugiyama K. Visualization of precut DSAEK and pre-stripped DMEK donor corneas by intraoperative optical coherence tomography using the RESCAN 700. BMC ophthalmology. 2016; 16:135.\u003c/li\u003e\n\u003cli\u003eEguchi H, Kusaka S, Arimura-Koike E, Tachibana K, Tsujioka D, Fukuda M, Shimomura Y. Intraoperative optical coherence tomography (RESCAN((R)) 700) for detecting iris incarceration and iridocorneal adhesion during keratoplasty. International ophthalmology. 2017; 37:761-5.\u003c/li\u003e\n\u003cli\u003eDas S, Kummelil MK, Kharbanda V, Arora V, Nagappa S, Shetty R, Shetty BK. Microscope Integrated Intraoperative Spectral Domain Optical Coherence Tomography for Cataract Surgery: Uses and Applications. Current eye research. 2016; 41:643-52.\u003c/li\u003e\n\u003cli\u003ePahuja N, Shetty R, Jayadev C, Nuijts R, Hedge B, Arora V. Intraoperative Optical Coherence Tomography Using the RESCAN 700: Preliminary Results in Collagen Crosslinking. 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Direct measurement of the ciliary sulcus diameter by 35-megahertz ultrasound biomicroscopy. Ophthalmology. 2007; 114:1685-8.\u003c/li\u003e\n\u003cli\u003eReinstein DZ, Archer TJ, Silverman RH, Rondeau MJ, Coleman DJ. Correlation of anterior chamber angle and ciliary sulcus diameters with white-to-white corneal diameter in high myopes using artemis VHF digital ultrasound. Journal of refractive surgery. 2009; 25:185-94.\u003c/li\u003e\n\u003cli\u003eKawamorita T, Uozato H, Kamiya K, Shimizu K. Relationship between ciliary sulcus diameter and anterior chamber diameter and corneal diameter. Journal of cataract and refractive surgery. 2010; 36:617-24.\u003c/li\u003e\n\u003cli\u003eNemeth G, Hassan Z, Szalai E, Berta A, Modis L, Jr. Comparative analysis of white-to-white and angle-to-angle distance measurements with partial coherence interferometry and optical coherence tomography. Journal of cataract and refractive surgery. 2010; 36:1862-6.\u003c/li\u003e\n\u003cli\u003eGao J, Liao RF, Li N. Ciliary sulcus diameters at different anterior chamber depths in highly myopic eyes. Journal of cataract and refractive surgery. 2013; 39:1011-6.\u003c/li\u003e\n\u003cli\u003eBiermann J, Bredow L, Boehringer D, Reinhard T. Evaluation of ciliary sulcus diameter using ultrasound biomicroscopy in emmetropic eyes and myopic eyes. Journal of cataract and refractive surgery. 2011; 37:1686-93.\u003c/li\u003e\n\u003cli\u003eLee H, Kang SY, Seo KY, Chung B, Choi JY, Kim KS, Kim TI. Dynamic vaulting changes in V4c versus V4 posterior chamber phakic lenses under differing lighting conditions. American journal of ophthalmology. 2014; 158:1199-204 e1.\u003c/li\u003e\n\u003cli\u003eTitiyal JS, Kaur M, Sahu S, Sharma N, Sinha R. Real-time assessment of intraoperative vaulting in implantable collamer lens and correlation with postoperative vaulting. European journal of ophthalmology. 2017; 27:21-5.\u003c/li\u003e\n\u003cli\u003eLee H, Kang DSY, Choi JY, Ha BJ, Kim EK, Seo KY, Kim TI. Analysis of pre-operative factors affecting range of optimal vaulting after implantation of 12.6-mm V4c implantable collamer lens in myopic eyes. BMC ophthalmology. 2018; 18:163.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-ophthalmology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"boph","sideBox":"Learn more about [BMC Ophthalmology](http://bmcophthalmol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/boph","title":"BMC Ophthalmology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"lenses, intraocular; lens implantation, intraocular, tomography, optical coherence, refractive surgery, post-operative vault.","lastPublishedDoi":"10.21203/rs.3.rs-123289/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-123289/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eThe prediction of implantable Collamer lens (ICL) vaulting is one of the most important parameters for ICL implantation for safety, aqueous humor circulation, and lens transparency.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e This was a retrospective study. A RESCAN 700 was used for intraoperative observation of vaulting. Spectral-domain optical coherence tomography was used for imaging. \u003c/p\u003e\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eFinally, 51 patients (102 eyes) were included in the study. Compared with the eyes with normal vaulting, those with high vaulting had higher preoperative diopter values (P=0.039), lower preoperative corrected visual acuity (P=0.006), lower preoperative intraocular pressure (P=0.029), higher preoperative anterior chamber depth (P=0.004), lower preoperative crystalline lens rise (P=0.046), higher ICL spherical equivalent (P=0.030), higher intraoperative vaulting (P\u0026lt;0.001), and lower intraocular pressure at 1 month (P=0.045). The multivariable analysis showed that the only factors independently associated with high vaulting at 1 month after surgery was the intraoperative vaulting value (odds ratio=1.005, 95% confidence interval: 1.002-1.007, P\u0026lt;0.001). The intraoperative and 1-month postoperative vaulting values were correlated (R\u003csup\u003e2\u003c/sup\u003e=0.562).\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConclusions: \u003c/strong\u003eThe RESCAN700 system can be used to perform intraoperative optical coherence tomography to predict the vaulting value at 1 month.\u003c/p\u003e","manuscriptTitle":"Correlation between vaulting intraoperative and postoperative of EVO implantable Collamer lens: a retrospective study of real-time observations of vaulting using the RESCAN 700 system","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2020-12-29 21:30:15","doi":"10.21203/rs.3.rs-123289/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Major revision","date":"2021-02-22T05:03:55+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2021-02-18T11:19:57+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"b09cf488-1a95-4126-95f0-fdb2aa628620","date":"2021-02-02T23:04:48+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2021-01-07T11:03:08+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"386f0786-a262-4e16-924c-b982dccfd5f7","date":"2021-01-04T17:44:57+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2021-01-04T13:21:12+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2021-01-04T13:12:47+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2020-12-29T03:28:16+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2020-12-28T17:38:00+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Ophthalmology","date":"2020-12-07T08:21:17+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-ophthalmology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"boph","sideBox":"Learn more about [BMC Ophthalmology](http://bmcophthalmol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/boph","title":"BMC Ophthalmology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"1ae85c37-e64c-4c75-a305-ea8518fb2e51","owner":[],"postedDate":"December 29th, 2020","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":1658282,"name":"Ophthalmology"}],"tags":[],"updatedAt":"2022-01-03T11:50:43+00:00","versionOfRecord":{"articleIdentity":"rs-123289","link":"https://doi.org/10.1186/s12886-021-02237-2","journal":{"identity":"bmc-ophthalmology","isVorOnly":false,"title":"BMC Ophthalmology"},"publishedOn":"2022-01-03 11:50:43","publishedOnDateReadable":"January 3rd, 2022"},"versionCreatedAt":"2020-12-29 21:30:15","video":"","vorDoi":"10.1186/s12886-021-02237-2","vorDoiUrl":"https://doi.org/10.1186/s12886-021-02237-2","workflowStages":[]},"version":"v1","identity":"rs-123289","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-123289","identity":"rs-123289","version":["v1"]},"buildId":"omnImTCwR2MFx8CMYfrG7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}