Repeated rotation of a toric implantable collamer lens

Abstract

Introduction: Implantable collamer lens have been used widely worldwide, and have been accepted by more and more doctors and patients due to good safety, stability, and effectiveness. However, there is still a problem of crystal rotation. The large angle rotation (over 10°) would weaken the original astigmatism correction effect and even induce irregular astigmatism, seriously affecting the visual quality of patients. Herein, we reported a case who had 2 times of crystal rotations after toric implantable collamer lens (TICL) implantation. Patient concerns: The patient was a 38-year-old man who underwent TICL implantation for the correction of high myopic astigmatism in eyes. He presented a sudden decrease in the visual acuity (VA) of the left eye 4 months after the TICL implantation. The uncorrected visual acuity (UCVA) was 8/20 (refraction, +2.25 −5.25 × 68). Diagnosis: Rotation of TICL was diagnosed. The toric marks with a rotation of 75° counter-clockwise from the original position were observed. Interventions: The TICL was re-set to the original position, leading to the UCVA of 12/20 in the left eye (refraction, −0.00 −0.75 × 131), with the vaulting of 589 μm. Ten months after the TICL relocation, the patient again presented a sudden decrease in the VA of the left eye, with the UCVA of 2/20 (refraction, +2.25 −5.00 × 66). Again, the toric marks with a rotation of 75° counter-clockwise from the original position was observed, just at the same position as the last rotation. This time, the TICL was removed. The axis and power were recalculated, and a new TICL was implanted, with the rotation of 73° counter-clockwise from the horizontal line of the temporal side. Outcomes: The patient obtained a final UCVA of 12/20 in the left eye (refraction, +0.50 −0.50 × 26), which remained stable in the 6-month follow-up period, with the vaulting of 602 μm. Lessons: Rotation is a common complication after TICL surgery. Relocation or replacement of TICL are safe and efficient ways to recover VA due to TICL rotation.

Factors leading to realignment or exchange after implantable collamer lens implantation in 10 258 eyes

“…It should be noted that in 2 eyes, the cylinder decreased by ≤0.25 D, and UDVA was not improved at the most recent follow-up compared with presurgery levels. After ICL realignment, misalignment could be corrected for a short time, but the ICL later rotated again, which was in line with the case report of Zhang et al 17 An underlying reason may be that the ciliary sulcus was overly oval, resulting in an unstable position of the TICL. For these patients, customized sizing and positioning of TICLs may be helpful.…”

Implantable Collamer Lens Subluxation in a Patient with Lenticular Coloboma: A Case Report

“…In patients who undergo spherical ICL implantation and with poor stability, a change in the axis of the ICL may provide lens stability [ 17 ]. However, this was not an option in our case, as the intended axis was required for correcting the cylindrical component of the refractive error [ 18 ]. Additionally, the low ICL vault observed with subluxation in our case was another reason for explantation, as it is associated with inducing cataractous changes due to ICL-lens capsule contact [ 17 , 19 ].…”