Icl Rotation Following Extreme Weight Loss In A Patient With Keratoconus

This case report describes a 27-year-old female with keratoconus who underwent toric ICL implantation and developed lens rotation 18 months later, following significant weight loss after bariatric surgery. We propose a potential link between weight loss and changes in anterior chamber depth (ACD), which may affect ICL positioning and stability.

A twenty seven year-old female with a history of mild keratoconus in both eyes presented for refractive surgery. She was offered toric ICL implantation due to her high refractive error and keratoconus. Postoperatively, the patient achieved stable visual acuity of 1.0 in both eyes. Follow-up visits at one week, one month, and six months showed unaided vision of 1.0. Eighteen months later, she reported a sudden decrease in vision. Clinical examination showed that ICL had rotated in both eyes.

patient underwent bariatric surgery and lost 35 kilos. it was hypothesized that the significant weight loss may have caused changes in the anterior chamber due to resorption of periocular fat, potentially leading to an increase in anterior chamber depth (ACD) and affecting the ICL's positioning. Changes in orbital fat and a reduction in orbital content could lead to a wider anterior chamber and shift the ICL's position. 

This case report explores the potential effect of bariatric surgery and substantial weight loss on ICL rotation in a keratoconus patient.  No study was found with any reports on the effect of extreme weight loss on ICL implantation and rotation. This case highlights an unexpected complication following ICL implantation in a keratoconus patient, with ICL rotation occurring 18 months postoperatively.The rotation was likely influenced by significant weight loss after bariatric surgery, which resulted in changes in anterior chamber dynamics and ICL positioning. This is the first reported case linking extreme weight loss to ICL rotation.

Keratoconus is a progressive corneal thinning disorder that causes irregular astigmatism and myopia. Corneal Cross-Linking (CXL) and toric ICL implantation have become important therapeutic interventions for managing keratoconus and correcting refractive errors. However, the impact of systemic factors such as extreme weight loss on the stability of ICL implants has not been well studied 

Clinicians should consider such factors when planning for ICL surgery in patients with substantial weight fluctuations, especially those undergoing bariatric surgery.