/Purposes/Objective : This study reports 15-year outcomes of implantable collamer lens (ICL) surgery in high myopia, analyzing complications, cataract surgical efficacy, and ultrastructural mechanisms of anterior subcapsular cataract (ASC). This retrospective study included 1,208 eyes (ICL V4) and 6,258 eyes (ICL V4c) from Fudan University Eye Ear Nose and Throat Hospital, Shanghai, China. Follow-ups occurred preoperatively, at 1/3/6 months, annually post-ICL, and 1 month post-cataract surgery. Lens opacity, ASC rates, and complications were evaluated. Anterior capsule ultrastructure was assessed using scanning/transmission electron microscopy (SEM/TEM). The ICL V4 group (follow-up: 23.12±32.06 months) exhibited higher complication rates than V4c (8.95±17.40 months): lens opacity (6.46% vs. 0.16%), ASC (2.32% vs. 0.10%), and bilensectomy(5.13% vs. 0.16%). Bilensectomy improved corrected distance visual acuity from 0.56±0.39 to 0.34±0.51 logMAR (P=0.006), restoring pre-ICL levels (P=0.310), with safety/efficacy indices of 1.08±0.11 and 0.99±0.08. Myopia-related complications included myopic macular atrophy (0.38%), choroidal neovascularization (0.24%) and retinal detachment (0.04%). SEM/TEM revealed lens epithelial cell proliferation, fibronectin or collagen deposition, and endoplasmic reticulum abnormalities (thickened cristae, perinuclear vacuolization) in ASC cases. Super high myopia, shallow anterior chamber depth, and older age are key risk factors for post-ICL cataract. While bilensectomy restores vision, high myopia-related complications persist. ASC pathogenesis involves mechanical damage and metabolic dysfunction, evidenced by ultrastructural changes. These findings underscore the need for long-term monitoring in ICL patients with high myopia. • This study provides, to our knowledge, the first ultrastructural analysis using scanning and transmission electron microscopy of cataracts developed after both ICL V4 and ICL V4c implantation. • The findings reveal that the pathogenesis of post-ICL cataract involves a dual mechanism of mechanical damage and metabolic dysfunction. • We further identify key risk factors for this complication, including super high myopia, shallow anterior chamber depth, and older age.
Jiang et al. (Sun,) studied this question.