Influence of Lighting, Accommodation, and Pharmacological Conditions on Vault After ICL Implant Refractive Surgery: A Systematic Review

Purpose To determine the influence of lighting conditions, accommodation, and the use of drugs on vault measurement in patients implanted with an Implantable Collamer Lens (ICL; STAAR Surgical). This is the first systematic review to date that analyzes published articles assessing vault variation when measured under different lighting, accommodative, and pharmacological conditions. Methods A systematic review was conducted, including studies reporting vault measurement under different lighting, accommodative, or pharmacological conditions, in two databases: PubMed and Scopus. The search period was from February 2004 to December 14, 2024. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and the National Heart, Lung, and Blood Institute's Quality Assessment Tool for Case Series Studies was used to evaluate the quality of the included studies. Results This systematic review included 22 studies and a total of 1,690 eyes from 1,094 patients. The influence of lighting conditions, accommodation, and drug use was analyzed in 13, 8, and 6 studies, respectively. Vault decreased from 542.12 ± 103.35 to 442.94 ± 102.76 µm ( P < .001) when measured under photopic lighting conditions; this reduction was more evident in patients implanted with V4c models compared to V3 and V4 models. Conclusions The value of the vault is susceptible to changes depending on the conditions under which it is measured. The vault decreases under photopic lighting conditions, as well as during the accommodative state and after administration of miotic and mydriatic drugs. [ J Refract Surg . 2025;41(6):e611–e621.]