Outcome And Risk Factors Of Subluxation And Delyed Dislocation Of Implantable Collamer Lens

to present the patient background and management of three cases of early spontaneous subluxation and delayed dislocation of implantable collamer lens (ICL). 

Two patients developed traumatic dislocation 5 and 7 years after ICL implantation. The third case presented inferior subluxation in an eye with anisometropia and unilateral lenticular coloboma.

Two men, aged 27 and 29, presented with painless vision blurring and peaked pupils. Optical coherence tomography confirmed the dislocation of the one-foot plate in front of the iris. They underwent immediate ICL repositioning. At four years of follow-up, corneas remain clear, the changes in endothelial cell counts are clinically insignificant, and their best-corrected vision is retained back to the pre-trauma level of 20/25. A 27-year-old man with a Marfanoid body habitus presented with low central ICL vaulting, the previously implanted temporal footplates resting over the lenticular defect inferiorly in the right eye. A high-resolution ultrasound biomicroscopy confirmed the presence of a ciliary body (CB) cyst at the 9 o’clock position. He underwent an urgent explantation of the unstable ICL.

Subluxation and dislocation of an ICL are rare but carry the risk of long-term complications. Ophthalmologists should identify dislocation and timely intervention that can mitigate the risk of complications. We highlight the challenges and limitations of ICL implantation in patients with lens defects and unprecedented CB cysts. Selecting smaller lenticular colobomas and avoiding direct interaction between the weak zonules area and the ICL haptics are essential steps to ensure the stability of the implanted lens.