Comparison of the Outcomes of Implantable Collamer Lens Surgery Performed by Fellows and Consultants in a Tertiary Eye Care Hospital.

Abstract

Purpose: To compare the long-term outcomes and complication rates of implantable collamer lens (ICL) surgeries performed by fellows-in-training and consultant surgeons at a tertiary eye care hospital.

Patients and methods: This was a retrospective cohort study. A chart review was performed for all patients who underwent ICL surgery for myopia and compound myopic astigmatism between January 2015 and December 2018 at King Khaled Eye Specialist Hospital and Reseach center, Riyadh, Saudi Arabia. Patients who underwent ICL implantation for hyperopia, keratoconus, or post-keratoplasty were excluded from the study. The outcomes and complication rates were compared based on whether the primary surgeon was a fellow (fellow group) or a consultant surgeon (consultant group). The primary outcome measure was the development of cataracts or endothelial cell loss, and the secondary outcome measure was visual acuity at each postoperative visit.

Results: A total of 182 eyes (114 patients) underwent ICL surgery for myopia. Mean spherical equivalent was -9.74±3.51 D for the fellow group and -9.96 ± 3.77 D for the consultant group. A toric ICL was placed in 73 (86.9%) and 80 eyes(83.6%) in the fellow and consultant groups, respectively. The median postoperative follow-up (interquartile range) for patients operated on by fellows and consultants was 31.50 (32) months and 28 (33) months, respectively. There was no statistical difference in the median change in endothelial cell count (ECC) between the groups (p = 0.812). Postoperatively, cataract developed in six eyes during follow-up; two were ICL-related. The mean LogMAR uncorrected distance visual acuity was 0.11 ± 0.14(20/25) and 0.11 ± 0.16(20/25) in the fellow and consultant groups, respectively. Visual acuity outcomes and complication rates were comparable between groups.

Conclusion: ICL implantation provided good refractive outcomes and long-term stability. There were no significant differences in postoperative ECC loss, cataract development, or other complications according to different levels of surgical experience.