Spontaneous rotation of a toric implantable collamer lens related to abnormal ciliary body morphology: a case report

Abstract

Background: This is a case of spontaneous toric implantable collamer lens (TICL) rotation that occurred twice in the left eye of a patient. Case presentation: A 24-year-old gentleman received TICL implantation for treatment of myopic astigmatism encountered with spontaneous rotation of approximately 90°from its original position. TICL reposition procedure was performed with visual outcome of 20/16. Surprisingly, a re-rotation of TICL occurred. The patient underwent a replacement of non-toric ICL with a larger size after careful re-evaluation with final visual outcome of 20/20. A short and small ciliary process with shallow ciliary sulcus and posteriorly positioned ciliary body was found by Ultrasound Biomicroscopy (UBM). Conclusions: The unique morphology of the ciliary body may have a potential association with the vault and instability of implanted ICL. Careful examination of the ciliary body morphology is essential in preoperative evaluation.

Analysis of perioperative problems related to intraocular Implantable Collamer Lens (ICL) implantation

“…Spontaneous rotation is a common postoperative complication. For patients with ICL implantation, spontaneous rotation only affected the arch height of patients to a certain extent, and for patients with TICL, it resulted in a significant loss of visual acuity [ 93 , 94 ]. The incidence of spontaneous rotation of TICL was about 0.12% [ 86 ].…”

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

“…Although no significant variation in the difference between TICL size and WTW was found between the ICL realignment or exchange and control groups, for cases with a much greater STS compared with WTW or with a unique morphology of the ciliary sulcus, such as patient 11, the ICL could be undersized when using the standard WTW/ACD-based sizing, as proposed by the manufacturer (STAAR Surgical). 15 Another possible explanation is that the misalignment may be related to surgery, such as intraoperative misalignment or dislocation of the haptics. It is worth clarifying that the axis placement using systems such as the VERION or Zeiss Calisto can improve the precision of placement of the TICL during the initial surgery.…”

Late-Onset Toric Implantable Collamer Lens Rotation: A Case Report

“…However, we cannot completely rule out the possibility that the patient had personal reasons for concealing an accident. Incorrect sizing is another possible reason for ICL rotation described in the literature 1 , 13 ; however, the adequate vault size speaks against this contributing factor. On the other hand, a high discrepancy between the vertical and horizontal sulcus-to-sulcus distance has shown to be a contributing factor for ICL rotation 15 , which cannot be excluded in our case as these UBM measurements were not performed.…”

“…The Evo Vision Toric Implantable Collamer Lens (TICL; Model V4c, STAAR Surgical, Nidau, Switzerland) is a posterior chamber phakic intraocular lens designed to correct myopia and astigmatism in a safe, highly efficient, and reversible manner 1 , 3 , 4 , 5 , 6 , 7 , 10 , 12 . Its central port eliminates the need for preoperative iridotomies to prevent pupillary block and due to its hydrophilic collamer material, it provides high biocompatibility 2 , 5 , 6 .…”