PURPOSE: To evaluate the outcomes of small-aperture IC-8 IOL implanted in patients with significant preexisting corneal comorbidities.

PATIENTS AND METHODS: This retrospective chart review included case records of 45 consecutive patients (67 eyes) with preexisting corneal irregularities who underwent cataract surgery and implantation of a small-aperture IC-8 IOL. Outcome measures included uncorrected distance visual acuity (UDVA), spherical equivalent refraction (SER), and spherical equivalent refractive prediction accuracy of five IOL formulas (Barrett Universal II, Emmetropia Verifying Optical (EVO), Kane, Hill-Radial Basis Function (Hill RBF), prediction enhanced by artificial intelligence and output linearization by Guillaume Debellemanière, Damien Gatinel, and Alain Saad (Pearl DGS) using biometry measurements from IOLMaster 700 and Pentacam.

RESULTS: Of the 67 eyes, 56 underwent IC-8 IOL implantation only, while 11 required piggyback IOL as a secondary procedure. Mean postoperative UDVA in IC-8 only eyes was 0.24 ± 0.30 logMAR, with 61.1% (33/54) achieving UDVA of 6/9 or better. Mean postoperative SER in these eyes was −0.17 ± 1.27 D, with 54.2% (26/48) and 81.3% (39/48) of eyes achieving postoperative SER within 0.50 and 1.00 D, respectively. Refractive prediction accuracy of 5 IOL formulas was similar, with no significant differences in the precision and accuracy of IOL formulas and biometry measurements evaluated. Eyes that underwent piggyback implantation showed a UDVA of 0.42 ± 0.39 logMAR, with 36.4% (4/11) of eyes achieving UDVA of 6/9 or better postoperatively.

CONCLUSION: IC-8 IOL implantation in patients with irregular corneas was safe and effective, yielding good visual and refractive outcomes in this niche population, who typically have suboptimal outcomes. The authors suggest updating the clinical guidelines for the use of IC-8 to aid IOL selection in this challenging patient population. Keywords: small-aperture IC-8 IOL, corneal comorbidities, cataract surgery, refractive prediction accuracy