Corneal Refractive Surgery (Bioptics) After Repeated Rotation Of A Toric Implantable Collamer Lens. A Case Report

The Visian Toric Implantable Collamer Lens (TICL) (STAAR Surgical, Nidau, Switzerland) is a foldable lens designed to correct myopia and myopic astigmatism. Previous studies have revealed that the position of the V4C TICL in the eye is stable with an average rotation angle of 3.39 ± 2.36°. According to the current literature, there is only few reports of unforced TICL rotation that led significant decrease in visual acuity and required further surgical procedures. Here, we present an infrequent case in which a TICL spontaneously rotated approximately 70° twice. After the TICL reposition procedure in the operating room failed we finally successful manage the case with a FemtoLasik surgery touch up.

Instituto de Microcirugía Ocular (IMO Miranza) , Barcelona , Spain 

We present a case of 2 times toric implantable collamer lens (TICL) spontaneous rotation in one eye of a patient with bilateral myopic astigmatism. A 35-year-old male underwent TICL implantation in both eyes.Preoperative uncorrected distance visual acuity (UDVA) was 1.30 LogMar on each eyes, with refractive error of –3.75 –3.75 × 5° and –3.50 –3.50 × 170° both eyes achieved a corrected distance visual acuity (CDVA) of 0.00 LogMar. At the first week right eye achieved an UCVA of 0.30 LogMar and manifest refraction was +0.50-2.00 x 32°. For the first rotation of the TICL,  axis adjustment was performed at the operating room under topical anesthesia using the Batlle ICL manipulator, we realigned the TICL according at the desired axis.After 5 weeks of successful TICL axis reposition in the right eye, the patient presented with a sudden decrease in visual acuity. UDVA was of 0.30 LogMar and manifest refraction was plano -1.75 x 33°. We observed the toric marks again with a 20° rotation from the original position and decided to proceed with a Bioptics procedure through a FemtoLasik, obtaining a final UDVA of 0.00 LogMar, which remained stable at 3 months’ follow-up.TICL can present a considerable rotation that compromises visual acuity. The relocation of TICL is a safe and effective procedure to recover visual acuity due to significant spontaneous TICL rotation however sometime corneal refractive procedure should be an effective supplementary tool instead of a TICL replacement.

 Bioptics offered a safe, predictable, and efficient outcomes for residual myopic astigmatism and can be considered an option if toric ICL recolocation is not effective. Results confirm that wavefront-guided photoablation remains an excellent option to manage residual refractive error after phakic IOL.