ESCRS - PO0076 - An Upside-Down Implantable Collamer Lens In A Patient With Previous Lasik – Intraocular Lens Power Selection Challenge

An Upside-Down Implantable Collamer Lens In A Patient With Previous Lasik – Intraocular Lens Power Selection Challenge

Published 2023 - 41st Congress of the ESCRS

Reference: PO0076 | Type: Case report | DOI: 10.82333/atjq-3e98

Authors: Bruna Cunha* 1 , Diogo Hipolito-Fernandes 2 , Nuno Alves 3 , Miguel Trigo 4 , José Pita-Negrão 4

1Ophthlamology,Centro Hospitalar Universitário de Lisboa Central,Lisbon,Portugal, 2Ophthlamology,Centro Hospitalar Universitário de Lisboa Central,Lisbon,Portugal;Ophthlamology,Hospital CUF Descobertas,Lisbon,Portugal, 3Ophthlamology,Hospital CUF Descobertas,Lisbon,Portugal;Ophthlamology,Centro Hospitalar Universitário de Lisboa Central,Lisbon,Portugal, 4Ophthlamology,Hospital CUF Descobertas,Lisbon,Portugal

To report a case of a cataract surgery combined with the explant of an upside-down implantable collamer lens (ICL) in a patient with a previous extreme myopic LASIK, exposing the challenges regarding the intraocular lens (IOL) power selection.

Ophthalmology Department, Hospital CUF Descobertas, Lisbon, Portugal

A 48-year-old male presented to the Ophthalmology department complaining of progressive painless visual loss on his right eye (OD). He had a previous history of: 1) myopic LASIK in both eyes (OU) 20 years before, with no preoperative data available; 2) implantation of an ICL OU 8 years before; 3) cataract surgery with multifocal IOL on his left eye (OS). He was treated with a prostaglandin analogue in OD for ocular hypertension. At presentation, best corrected visual acuity (BCVA) was 20/63 OD (+2.00 -4.00x80) and 20/32 OS (+0.25 -1.50x95). Slit-lamp evaluation revealed a bilateral clear cornea with LASIK flaps, with an ICL and a posterior subcapsular cataract in OD and pseudophakia in OS.  Intraocular pressure (IOP) was 30 OD; unremarkable fundus examination. Anterior segment optical coherence tomography (AS-OCT) revealed an upside-down positioning of the ICL OD, causing irido-trabecular angle closure. OD ICL explantation followed by cataract surgery was decided. Preoperative evaluation showed an axial length of 32.92mm, anterior chamber depth 3.35mm, lens thickness 4.57mm and white-to-white distance of 12.33mm. AS-OCT showed K1: 29.32x92, K2: 31.57x2 with a central corneal thickness of 316 µm. The ASCRS IOL power calculator for prior myopic LASIK was used to determine the IOL power and a monofocal +19,5D one-piece IOL was implanted in the capsular bag. One-month after surgery, distance BCVA improved to 20/32 (+0.50 -4.00x95) and IOP was 19 mmHg under topical medication.

The placement of an upside-down ICL may lead to several complications, particularly progressive irido-trabecular angle closure, leading to glaucoma. Its surgical correction is mandatory. The IOL power calculation was particularly challenging given the long AL, combined with an extreme prior myopic LASIK with no preoperative data available, and an upside-down ICL. In such cases, careful and extensive multimodal preoperative assessment is determinant to achieve a successful result, particularly regarding the IOL power calculation and selection.