Five-Year Follow-up of Toric Posterior Chamber Phakic Intraocular Lens With Central Port Design in Patients With Low and Normal Vault

Purpose: To assess the clinical outcomes and postoperative complications of the EVO Toric Implantable Collamer Lens (TICL) (STAAR Surgical) with a central port correction over a 5-year follow-up in patients with low and normal vault. Methods: This retrospective study included 240 eyes from 120 patients divided in two groups based on early postoperative vault: low (< 250 μm; n = 77) and normal (⩾ 250 μm; n = 163). Uncorrected (UDVA) and corrected (CDVA) distance visual acuity, refraction, astigmatism vectorial analysis, complications, and secondary surgeries were assessed at 1 month, 12 months, and 5 years postoperatively. Results: At 5 years, both groups showed significant improvement in UDVA and CDVA ( P < .001), with no intergroup differences. The safety index was 1.17 ± 0.25 in the low vault group and 1.18 ± 0.32 in the normal vault group ( P = .634); efficacy index was 1.02 ± 0.24 and 1.00 ± 0.29, respectively ( P = .542). Manifest cylinder at 5 years was similar between groups: −0.41 ± 0.56 and −0.48 ± 0.61 diopters ( P = .526). Both groups demonstrate a similar tendency for undercorrection, with target induced astigmatism values higher than surgically induced astigmatism values, at 1 ( P = .813) and 5 ( P = .466) years. The mean deviation vector and correction index was statistically similar between groups ( P > .05). The absolute mean angle of error was also similar between groups ( P = .128). TICL axis repositioning occurred in 4 cases (5.19%) in the low vault group and in 5 cases (3.08%) in the normal vault group. Conclusions: TICL implantation provides excellent long-term refractive and rotational stability regardless of vault height. Low vault was not associated with significant safety concerns, supporting TICL efficacy across a broad range of postoperative vault values.