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Before ICL Surgery – 5 steps to increase safety

  • 4 min read

Before ICL surgery is performed there are certain steps to be taken by the surgeon and some by the candidate. This ensures safety and a wonderful outcome.

The ICL or Implantable Collamer lens is ultra thin lens with specific power and astigmatism correction designed to float between the colored part of the eye or Iris and the natural lens.This is a delicate surgery performed by skilled hands as the space the ICL is going to flat in is very less.


Step 1: Ensure Adequate Space for ICL

Experienced ICL surgeons, know that there should be enough space in the iris lens gap and the lens cornea gap before ICL surgery is contemplated. The latter is easier to measure. Laser measurement by IOL Master or similar technologies yield a number, which according to FDA should be 3mm or greater. Many surgeons in clinical practice prefer 2.85 or greater.

Step 2: Accurate Refraction

Before ICL surgery a very accurate refraction or determining the exact power needed to yield 20/20 is essential. Especially the astigmatism and its axis. ICL have to be ordered from the manufacture and some may be custom built. Unlike lasik eye surgery we do not have the luxury of changing the treatment on the day of the procedure.

Step 3: Determine the Right Size of ICL

We now have determine the power and axis of the ICL but before ICL surgery we also want to find out how much horizontal space is available fort the implantable lens. This can be measure only indirectly. The most popular method is using IOL Master 700, Lenstar 900, iDesign and comparable technologies. These instruments determine the junction of the cornea and sclera on either side on a horizontal axis. The measurement is commonly referred as to white to white, signifying where clear cornea transitions to white sclera. This number is proportional to the horizontal space available for the ICL.

Before ICL surgery Refraction, the center of the cornea, pupil sight and Corneal Scleral margins are all detected.
White to White measurement by artificial intelligence

The easiest method, and of course the least expensive method to obtain the measurement before ICL surgery is using a Digital Caliper.

Ultrasound in by a sonologist can actually peer into he space but this method is limited by reproducibility between observers.

Step 4: Surgeon Makes Laser Openings in Iris

The nutrient containing eye fluid circulates from behind iris through the pupil to the exit channels at cornea scleral junction called trabecular meshwork. ICL can block the flow if ICL occludes the pupil. This would lead to narrow angle glaucoma and extreme pain. To preempt this nuisance Dr. Khanna makes two openings in the iris with a YAG laser. The pupil is constricted with pilocarpine for this procedure called YAG iridotomy. A quick 1-2 minute procedure per eye, with fast recovery. The vision could be blurry due to liberation of pigment cells. It is imperative to have a designated driver.

Another way to avoid the pupillary block would with a lens which has holes to allow fluid to escape. This model called EVO has not been approved in USA>

Step 5: Start Drops Remove Contact Lens

Now we are getting closer to the actual procedure and onus shifts to the patient. You would need to disconitnue your contacts for 3 or more days. If this is not possible than atleast one day. Thats when you would start antibiotic drops 4 times a day which will continue 5-7 days after the ICL procedure. If you wear makeup especially eyeliner, it needs to be removed the prior night. The eyes need to be cleaned with Lid wipes and antibiotic drops put in.

If you have any more questions before ICL surgery, please contact us.

ICL for nearsightedness is FDA approved in the USA and manufactured by Staar.

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