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AI-Assisted UBM versus Conventional Sizing Approaches for ICL Implantation: A Retrospective Analysis of Vault
Robert Edward T Ang1,2, Cesar Emmanuel R Glipo2, Gladness Henna A Martinez2
1Cornea and Refractive Surgery Section, Asian Eye Institute, Makati City, Philippines.
Introduction:
To compare the effectiveness of an ultrasound biomicroscopy (UBM)-based nomogram with a white-to-white (WTW) nomogram in predicting postoperative vault in myopic patients undergoing implantable collamer lens (ICL) implantation.
Methods:
This retrospective, single-center study included 227 eyes from 116 myopic patients (mean age 28.9 ± 7.3 years). ICL sizing was determined using either the WTW OCOS nomogram (WTW group, 117 eyes, 60 patients) or the UBM ICL Guru nomogram (UBM group, 110 eyes, 56 patients). Postoperative evaluation at 1 month included uncorrected and corrected visual acuity, refraction, anterior chamber depth, axial length, intraocular pressure, and vault.
Results:
Demographic data showed 56 patients (36% male, 64% female) had a mean age of 28.82 ± 7.73 for the UBM group and, among 60 patients (43% male, 57% female), had a mean age of 28.98 ± 6.88 for the WTW group. Postoperative uncorrected and corrected visual acuity and refractive outcomes were comparable between the UBM and WTW groups, with no statistically significant differences observed. Mean vault differed significantly among the groups. The UBM group showed a lower average vault (472.3 ± 170.0 μm) compared with the WTW group (560.4 ± 251.7 μm, p < 0.1). Undervault (<250 μm) occurred in 9.1% of UBM versus 11.1% of WTW eyes. Overvault (750-1000 μm) was less frequent with UBM (3.6%) than with the WTW group (14.5%). Seven percent in the WTW group had excessively high vaults of greater than 1000 μm, with 6 eyes undergoing ICL exchange. Prediction error with the UBM nomogram was within 383 μm across all eyes at 1 month.
Conclusion:
Visual and refractive outcomes were similarly good in both the WTW group and the UBM group. While visual outcomes were similar, the UBM based ICL Guru nomogram achieved more precise postoperative vaulting than the WTW-based OCOS method. OCOS resulted in more overvaults and ICL exchanges, making ICL Guru the superior choice for consistent, ideal vault targeting.
