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

Background

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]. The advantage of TICL implantation compared to other refractive surgeries such as LASIK or photorefractive keratectomy is the lack of corneal disruption and potential reversibility [7]. Postoperative rotation of TICL is a well-known but rare complication. Causes of rotations include incorrect sizing, higher spherical power, intraoperative footplate misplacement, residual viscoelastic in the anterior chamber, and trauma [6], [7]. Typically, rotations occur within the first week [11]. Significant rotations (> 10°) are a rare phenomenon and account for about 1.7% of all cases [8], [9]. A rotation of 15° is sufficient to induce a 50% decrease of astigmatism reduction. Around 30° of misalignment neutralizes the effect of the TICL [2], [11]. Therefore, in the event of a significant rotation (> 10°), an operative readjustment is usually needed.

Publication History

Received: 17 August 2021

Accepted: 27 February 2022

Article published online:
26 April 2022

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