Rapid evaluation of vault post-ICL surgery using digital slit lamp microscope photography

To introduce a novel method using digital slit lamp microscope photography to efficiently and reliably estimate the vault value post-ICL (Implantable Collamer Lens) surgery.

Short-term and long-term post-operative patients who underwent Implantable Collamer Lens (ICL) implantation were enrolled in the study.The central hole of the ICL lens and its projection on the lens were documented using digital slit lamp microscope photography. Three ophthalmologists (DoctorA: an ICL expert, Doctor B: an ICL beginner, and Doctor C: ophthalmic resident) independently scored the images based on a predefined scale. The consistency and repeatability of the scores among the three ophthalmologists were calculated. Additionally, the correlation between the scores and the vault values measured by anterior segment optical coherence tomography (OCT) was analyzed, leading to the derivation of a regression equation.

A total of 259 anterior segment images from 132 patients were captured. The average scores given by three ophthalmologists were 4.76 ± 1.47, 4.81 ± 1.52, and 4.27 ± 1.08, demonstrating a high intraclass correlation coefficient (ICC) of 0.787 (p < 0.001). The highest ICC was observed between the ICL expert and ICL beginner (0.918, p < 0.001), while the lowest was between the ICL expert and ophthalmic resident (0.698, p < 0.001). The postoperative vault value averaged 619.52 ± 197.95 μm, showing a significant correlation with the score (R = 0.865, p < 0.001). Higher scores represent higher vaults.

The relationship between the ICL central hole and its projection on the lens facilitates a quick and reliable estimation of the vault value.