Unintended upside-down placement of a toric implantable collamer lens

Phakic intraocular lenses (pIOLs) offer an effective option for correcting high myopia in patients unsuitable for laser refractive surgery. We report a case of unintended upside-down implantation of a toric Implantable Collamer Lens (ICL), identified four months postoperatively. A 32-year-old male with corneal ectasia presented with left eye pain and bilateral dysphotopsia after bilateral ICL implantation performed elsewhere. Clinical evaluation revealed an inverted ICL in the right eye and toric axis misalignment in the left eye. Surgical management involved intraocular reinversion of the right ICL and axis realignment in the left eye. No postoperative complications occurred, and visual acuity remained stable. This case highlights the importance of early recognition of ICL malposition and demonstrates intraocular reinversion as a safe, effective alternative to explantation. Various diagnostic methods for confirming ICL inversion and the favorable refractive outcomes after corrective surgery are also discussed.