Repeated rotation of a toric implantable collamer lens: A case report
Haorun Zhang1, Mengjun Fu, Jiahao Wang
1Department of Refractive Surgery Center, Weifang Eye Hospital, Weifang, Shandong, China.
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.
