Buffering zone of implantable Collamer lens sizing in V4c

Background: The purpose of this study was to identify factors related to the unexpected vault in V4c implantable collamer lens (ICL; STAAR Surgical) implantation. Methods: V4c ICLs were implanted in 43 eyes of 43 patients for the correction of myopia. The implanted V4c ICL sizes were determined individually with our previous V4 ICL sizing nomogram based on the sulcus-to-sulcus diameter (STS), and the V4 ICL sizes were then converted to V4c ICL sizes with a size-converting table. We defined the "normalsizing group" as having a pre-converted ICL size larger than the STS, and the "under-sizing group" as having a preconverted ICL size smaller than the STS. Refractive outcomes, safety and parameters related to postoperative vault were compared between the two groups. Results: The value of "actual ICL size-STS" differed significantly between the normal-sizing and under-sizing groups (p< 0.001), but postoperative vault did not differ significantly (p = 0.442). The demographics, implanted ICL characteristics, effectiveness indexes, safety indexes, and parameters related to postoperative vault did not differ significantly between the two groups (p > 0.05). Two patients in the normal-sizing group exhibited over-vaulting; these patients had shallow anterior chambers and were implanted with high-dioptric-power ICLs. Conclusions: The achievement of acceptable vault in both normal-sizing and under-sizing groups indicates the existence of a buffering zone in V4c ICL sizing. The smaller size of V4c ICLs should be considered in patients susceptible to overvaulting, such as those with shallow anterior chambers and high-dioptric-power ICLs.