Key Surgical Steps for 4-Haptic Delivery Into the Posterior Chamber During Implantable Collamer Lens Surgery

Purpose: To introduce the key surgical steps of 4-haptic placement in the posterior chamber during Implantable Collamer Lens (ICL) implantation and evaluate the postoperative outcomes. Methods: This prospective observational study included 82 eyes that underwent ICL implantation from August 2024 to April 2025. Based on the number of haptics delivered into the posterior chamber after the injection, eyes were classified into three groups: 0–2-haptic group, 3-haptic group, and 4-haptic group. Surgical time and ophthalmic viscosurgical device (OVD) use was recorded intraoperatively and postoperative outcomes including visual acuity, refractive outcomes, vault, intraocular pressure (IOP), and corneal densitometry recorded at 1 day, 1 week, 1 month, and 3 months were analyzed. Central corneal endothelial cell density (ECD) was evaluated at 3 months postoperatively. Results: Both the 4-haptic and 3-haptic groups required significantly less OVD and shorter total operation, OVD injection, and haptic adjustment times than the 0–2-haptic group (all P < .001). Visual acuity, refractive outcomes, vault, and IOP were comparable among groups throughout the follow-up. Corneal densitometry was slightly higher in the 0–2-haptic group at 1 week and 1 month (10 to 12 mm posterior layer; P < .05). No significant differences in ECD were observed at 3 months. Conclusions: The 4-haptic delivery technique provides comparable safety and efficacy to the one-step OVD technique, in which the OVD is injected only after ICL insertion to adjust the haptics, while reducing intraoperative OVD use and operative time.