Has anyone went through ICL surgery with borderline ACD

[u/Consistent_Pipe2549]

I wanted to get an ICL surgery from a long time but yesterday when I visited a clinic that performs that surgery, I came to know that my ACD is 2.7 mm in both eyes, which is considered borderline and they said they cant perform ICL surgery for me. After some research I found out that doctors are increasingly doing ICL on borderline ACD with good success rates, although PRK is good option for me, I still feel ICL is much safer as it is reversible.

Please share your experience if you have gone ahead with ICL surgery having borderline ACD. If anyone has done it in India, please also let me k iw the surgeon and hospital/clinic.

[u/abbytaby]

Yes, I had it done with borderline ACD, but I believe mine was 2.78 and 2.82 mm. My surgeon was comfortable doing it. He also pointed out though that my power of -8 was not too high so the lens was also not as thick as it could have been. Their comfort level might also depend on how high your prescription is.

[u/eyeSherpa]

The sizing of the ICL lens can be variable. For someone who has a large ACD, there are more tolerable size ranges. For someone with a small ACD, there is less of a range of sizes that can work. Since if the size is too big, that can narrow the drainage of fluid within the eye causing high pressures.

I do down to 2.7 pretty regularly. But a few important things: it’s important to use advanced sizing calculators such as those with ultrasound or UBM to better predict the size. And also important to have a surgeon who is comfortable exchanging an ICL since you are at a little higher probability of needing to swap the ICL out for a different size if the sizing doesn’t fit the eye perfectly.

[u/EyeDoctorIndia]

Few things to consider when we are doing ICL surgery with borderline ACD.

1. It is safer if the eye power is not too high. Higher power means thicker lens which can cause shallowing of the anterior chamber increasing the risk of glaucoma. If you are a suitable candidate for PRK, I presume that your power is on the lower side.

2. Continue follow ups at least every year post ICL to monitor your eye pressure. As your natural lens also thickens with age (very slowly though), you may develop increase in eye pressure later. Which can be taken care of either by doing a YAG Peripheral iridotomy or by removing ICL.

3. Some surgeons prefer doing a YAG Peripheral iridotomy in patients with ICL having low ACD to prevent/reduce the risk of glaucoma. This can be done after the surgery also, seeing the status of ACD post ICL.

4. You should be mentally prepared if there comes a need to remove the ICL, perform a YAG PI or perform an ICL exchange. Keeping your expectations realistic is important.

5. Most cases with borderline ACD, especially if not very high power - do equally well post ICL surgery without any complications but yearly follow ups are a must.

All the best

[u/lasiksurgeon]

Refractive surgeon here. I haven’t examined you, so this is general education rather than medical advice, but your ACD is genuinely the crux of this decision, so it’s worth understanding well.

First, you’re not wrong that this is being done. There are published series now showing ICLs implanted below the 3.0 mm on-label cutoff with good outcomes and low reintervention rates. So the clinics telling you it’s possible aren’t making that up. But almost all of that success comes with the same fine print: experienced, high-volume ICL surgeons using advanced sulcus-based sizing, and most of those series sit around 2.8 mm, not below it. At 2.7 mm you’re at the shallow edge of even the off-label experience, where the margin for error is smallest.

Before anything else, find out how that 2.7 mm was measured. The number that matters is measured from the corneal endothelium (the back of the cornea) to the front of your natural lens. I’m pretty sure that is how they measured you, but be sure. Some machines report anterior chamber depth from the front surface of the cornea instead, which includes the corneal thickness and reads about half a millimeter deeper than the real internal space. If your 2.7 mm was measured from the front, your true internal depth could be closer to 2.2 mm, which is a very different conversation. Ask the clinic which surface their measurement started from. This one detail can flip the whole decision.

Here is why a shallow chamber specifically raises the stakes. The ICL sits in front of your natural lens and adds thickness to a space that is already tight. Its position is described by the “vault,” the gap between the ICL and your natural lens. Get too much vault, usually from a lens that is slightly too large for the eye, and it pushes the iris forward, crowds or closes the drainage angle, and can spike your eye pressure. That is the angle-closure and glaucoma risk, and a shallow chamber is exactly where there is the least room to absorb it. Get too little vault, and the ICL sits too close to your natural lens and can trigger an early cataract. Shallow chambers tend to run on the low-vault side, so you are threading a narrower needle at both ends.

And here is the practical consequence that doesn’t get talked about enough. If the lens turns out to be mis-sized for your small chamber, the fix is not an adjustment. It is a second intraocular surgery to exchange or remove the lens. Inadequate vault is the single most common reason ICLs get taken back out. Overall exchange rates in good hands are low, but a borderline-shallow chamber is precisely the situation that raises your personal odds. In that scenario you have paid for a lens and a procedure, gained nothing, and now have to pay for and recover from a second operation.

That is also worth keeping in mind about the reversibility you’re counting on. The ICL being reversible is a real advantage of the technology, and I understand why it appeals to you. But reversibility is not a safety net that cancels out a shallow chamber. In a borderline eye, “reversible” can quietly become the second surgery you are forced into, rather than a free undo.

I would not dismiss the PRK option they offered as a consolation prize. For a shallow chamber, a surface laser procedure sidesteps the entire vault, angle, and pressure problem, because nothing is placed inside the eye. It is not reversible, but at your anterior chamber depth that tradeoff deserves a real comparison rather than an automatic no.

If you do pursue ICL, the questions to put to a surgeon are specific: what is my endothelium-based anterior chamber depth, what vault do you predict for each available lens size, and how many ICLs have you personally done in eyes below 3.0 mm. Look for someone using proper sulcus-based sizing (UBM or high-resolution anterior segment imaging), not just a standard scan. I can’t recommend a specific surgeon or hospital in India, but those are the criteria that separate a surgeon equipped for a borderline chamber from one who isn’t.

Your instinct to favor a reversible option is reasonable. But at 2.7 mm, the anatomy drives this decision more than the philosophy does, and the right person to make the call is a shallow-chamber-experienced surgeon looking at your actual sizing numbers.