Indications for exchange or explantation of phakic implantable collamer lens with central port in patients with and without keratoconus

AIM:To evaluate the causes of phakic implantable collamer lens(ICL)exchange/explantation in patients with and without keratoconus(KC)at two tertiary hospitals in Riyadh,Saudi Arabia.METHODS:A retrospective chart review of all patients who underwent ICL(model V4 c with central port)exchange/explantation was performed using the electronic medical record systems.All available preoperative and postoperative data were documented for each patient.RESULTS:Over 7 y,2283 ICL implantation procedures were performed;46 implants(2%)required exchange(21 implants)/explantation(25 implants),of which 14 cases(30.4%)were patients with KC.Indications for ICL exchange/explantation in non-KC group were vault measurement,cataract formation,increased intraocular pressure,inaccurate refraction,and patient dissatisfaction in 22(68.75%),4(12.5%),3(9.37%),2(6.25%),and 1(3.12%)case,respectively.The most common indication for ICL exchange/explantation in the KC group was inaccurate vault sizing in 11 patients(78.57%),inaccurate refraction in 2 patients(14.28%),and patient dissatisfaction postoperatively in 1(7.14%)case.CONCLUSION:ICL implantation results in predictable refractive outcomes over the long term with exchange/explantation rates comparable to previous literature.Improper vault size is the most common cause of ICL exchange/explantation among patients with or without KC.