What question did this study set out to answer?

To examine early postoperative microvascular changes in the macular and peripapillary regions after ICL surgery in high myopia and their link to axial length changes.

March 21, 2026Clinical ophthalmology0 citationsOpen Access

Alterations in Macular and Peripapillary Vessel Density Following Implantable Collamer Lens Surgery in Highly Myopic Eyes and Their Potential Association with 2-Year Axial Length Changes

LMLihui Meng XLXinyu Liu YCYouxin Chen

Key Points

To examine early postoperative microvascular changes in the macular and peripapillary regions after ICL surgery in high myopia and their link to axial length changes.
Included 122 eyes from 61 high myopic patients undergoing ICL implantation.
Conducted optical coherence tomography (OCT) and OCT angiography (OCTA) preoperatively and at 1 day, 1 week, 1 month, and 3 months post-surgery.
Assessed outcomes such as corrected distance visual acuity, spherical equivalent, intraocular pressure, and various vessel density parameters.
At 3 months, significant improvements in spherical equivalent and corrected distance visual acuity were observed.
Global macular perfusion and vessel density decreased significantly post-surgery.
Peripapillary vessel density also showed significant reductions with notable regional variations.

Abstract

Purpose: To investigate early postoperative microvascular and structural changes in the macular and peripapillary regions after posterior chamber phakic intraocular lens (ICL) implantation in high myopia.Patients and Methods: This prospective cohort included 122 eyes of 61 patients with high myopia undergoing ICL implantation.Optical coherence tomography (OCT) and OCT angiography (OCTA) were performed preoperatively and at 1 day, 1 week, 1 month, and 3 months postoperatively.Outcomes included corrected distance visual acuity (CDVA), spherical equivalent (SE), intraocular pressure (IOP), axial length (AL), macular and peripapillary vessel density parameters, retinal thickness, choroidal thickness (CT), and choroidal vascularity index (CVI), analyzed globally and by sector.Results: At 3 months, SE and CDVA improved significantly (both P0.05).Global macular perfusion decreased, including total macular vessel density (MVD; =-4.11, 95% CI -5.78 to -2.44; P<0.0001) and macular smallvessel density (MSmVD; =-3.56, 95% CI -4.22 to -2.90; P<0.0001), with similar reductions across macular subregions.Layerspecific analysis showed reduced superficial vessel density (SVD; =-3.61, 95% CI -4.51 to -2.70; P<0.0001), whereas deep vessel density (DVD) showed no significant global change (=0.78,95% CI -0.63 to 2.18; P=0.279), with regional heterogeneity.Peripapillary vessel density also decreased (OVD: =-4.21, 95% CI -5.30 to -3.11; P<0.0001; OSmVD: =-2.11, 95% CI -2.85 to -1.36; P<0.0001), with sectoral variation.AL was negatively correlated with several macular and peripapillary vascular parameters (all P<0.05).In an exploratory sub-analysis (32 patients, 64 eyes) with 2-year AL follow-up, mean AL change was not significant, but greater 3-month foveal CT reduction was associated with longer AL at 2 years (estimate=-0.003mm/m; P=0.008).Conclusion: ICL implantation significantly improved visual and refractive outcomes and was accompanied by early macular and peripapillary microvascular and structural changes.Early postoperative CT changes may be associated with longer-term axial length outcomes.

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