Intraoperative OCT Enables Prediction of 3-Month Postoperative Lens Separation Vault for the Implantable Collamer Lens

Purpose To develop and test a multivariate model using intraoperative optical coherence tomography (iOCT) (ARTEVO 800; Carl Zeiss Meditec) to predict the 3-month lens separation vault of the Implantable Collamer Lens (ICL; STAAR Surgical). Methods A retrospective analysis of consecutive V4c EVO and EVO+ ICL procedures was conducted at London Vision Clinic, London, United Kingdom. ICL size was preoperatively chosen using Insight 100 VHF digital ultrasound (ArcScan, Inc) and the Reinstein ICL Sizing Formula V2. Central vault was recorded intraoperatively by iOCT. AS-OCT (MS-39; CSO Italia) measured vault at 30 minutes, 1 and 4 days, and 1 and 3 months after surgery. Stepwise multiple linear regression analysis evaluated the correlation between preoperative and iOCT-derived vault measurements with the 3-month vault. A predictive formula was derived and tested on 40 consecutive cases to estimate the accuracy and repeatability of vault prediction. Results A total of 153 eyes were included in the training set. Mean central vault was 829 ± 330 µm intraoperatively and 594 ± 218 µm at 3 months. Regression analysis indicated that intraoperative vault, ciliary body inner diameter, crystalline lens rise from the sulcus plane, and lens size were significant factors (all P < .001) in predicting the change between intra-operative and 3-month vault. The derived formula predicted the 3-month vault within 100 µm of the achieved vault for 58% of eyes in the test set, within 200 µm for 83%, within 300 µm for 93%, and within 350 µm for 100%. Conclusions iOCT is a valuable tool for intraoperative determination of lens size suitability, increasing patient safety, and potentially avoiding secondary procedures. [ J Refract Surg . 2025;41(6):e575–e584.]