Delayed Rotation Of A Toric Phakic Intraocular Lens Following Aggressive Eye Rubbing

The purpose of this study was to report an unusual case of delayed rotation of a Toric Phakic IOL following aggressive eye rubbing.

This is a case report and literature review.

A 30-year-old male underwent bilateral implantation of Visian Toric Implantable Collamer Lens (TICL) (STAAR Surgical, Nidau, Switzerland). On the first post-operative day, his uncorrected vision was 6/6 in both eyes and vaulting was 346 microns and 436 microns in his right and left eyes, respectively. The vision was stable for 6 months after the surgery. After 6 months, he presented with a complaint of sudden onset diminution of vision in his left eye following aggressive eye rubbing a few hours earlier. On examination, his uncorrected vision was 3/60 in the left eye. Dilated examination revealed TICL axis to be at 90 degrees instead of the original placement axis of 179 degrees, and vaulting was 378 microns. Ultrasound biomicroscopy (UBM) revealed no ciliary sulcus or ciliary body abnormalities. TICL realignment was done surgically and his vision improved to 6/6 which stayed stable on further follow-ups.

Delayed rotation of a Toric Phakic IOL in the presence of adequate vault is extremely rare. Aggressive eye rubbing should be considered a risk factor for Toric Phakic IOL rotation even after several months of implantation.