Changes In Astigmatism After Implantation Of Non-Toric Icl In A Patient With High Astigmatism

Toric ICL (TICL) surgery can effectively treat high astigmatism, but the accuracy and stability of TICL axis positioning are critical. As astigmatism severity increases, precise alignment becomes even more important. At our hospital, routine UBM (Ultrasound Biomicroscopy) screening is conducted before TICL surgery. If posterior chamber issues like a wide posterior chamber angle or ciliary body abnormalities (e.g., shortening, flattening, or absence) are detected, TICL surgery is approached cautiously. In such cases, combined procedures, such as ICL implantation followed by LASIK, may be considered to enhance stability and prevent adverse visual outcomes.

Wuhan Hongshan Aier Eye Hospital,Wuhan,China

A 22-year-old female with a 10-year history of progressive myopia sought refractive surgery. Her preoperative refraction was:

Right eye: -6.25/-4.50 × 177 = 0.9
Left eye: -6.75/-3.75 × 2 = 0.9
She was highly sensitive to astigmatism axis deviations, with more than 5 degrees causing a loss of over two lines of visual acuity. Corneal thickness was 508 μm (OD) and 506 μm (OS), and corneal topography was normal. UBM showed a wide posterior chamber angle with ICA >120 degrees in some quadrants, and a flat ciliary body with short/absent ciliary processes.

Given the patient's posterior chamber abnormalities, a TICL implant was considered risky due to low vaulting. A combined surgical approach was chosen: ICL for myopia correction and LASIK for residual astigmatism. LASIK was delayed by three months due to personal circumstances.

Postoperatively:

Day 1 after ICL: Visual acuity 0.8 in both eyes.
1 Week Post-ICL: Visual acuity 0.8, with significant astigmatism reduction (OD: +0.25/-1.75×180 = 1.0, OS: +0.25/-0.75×6 = 1.0).
3 Months Post-ICL: Visual acuity 0.8, further astigmatism reduction (OD: +1.50D, OS: +1.25D).
LASIK was performed to correct residual astigmatism:

Day 1 post-LASIK: UCVA 1.0.
1 Year Post-ICL + LASIK: Visual acuity 1.2 in both eyes.
The patient achieved excellent outcomes with stable vision and reduced astigmatism.

In a case of combined ICL implantation followed by LASIK, a patient with high astigmatism experienced an unexpected reduction in astigmatism about three months after non-astigmatic ICL implantation. This decrease wasn't due to surgically induced astigmatism (SIA) from the incision. The patient achieved good visual acuity even before LASIK correction. The outcome may be related to the ICL’s optimal positioning and optical compensation through visual feedback and accommodation. This highlights the need for detailed preoperative evaluation and planning for patients with high astigmatism. Further studies are needed to explore the mechanisms behind this effect and refine surgical strategies.