TORIC IMPLANTABLE COLLAMER LENS FOR RESIDUAL REFRACTIVE ERROR IN A PSEUDOPHAKIC EYE WITH PREVIOUS PENETRATING KERATOPLASTY
Published 2026 - 30th ESCRS Winter Meeting
Reference: PO012 | Type: Case Report | DOI: 10.82333/h7mm-y175
Authors: Eriks Elksnis* 1 , Vincenzo Rizzuto 1 , Eva Elksne 2 , Evija Gulbinska 3
1Latvian American Eye Center,Riga,Latvia;Riga Stradins University,Riga,Latvia, 2Riga Stradins University,Riga,Latvia;Children Clinical University Hospital,Riga,Latvia, 3Latvian American Eye Center,Riga,Latvia
Purpose
To illustrate the potential of toric implantable collamer lens (TICL) implantation in complex and challanging case as an effective alternative for managing residual ametropia and irregular astigmatism in pseudophakic eyes after corneal transplantation.
Setting
A tertiary ophthalmology center specializing in cataract, corneal and refractive surgery.
Report of case
A 40-year-old pseudophakic woman with a history of PK for herpetic stromal keratitis presented with high irregular astigmatism and poor visual quality despite spectacles and a rigid contact lens trial. Preoperative metrics included uncorrected distance visual acuity (UDVA) 0.3, best-corrected distance visual acuity (BCVA) 0.9, manifest refraction +3.50/−6.50 × 55°, root mean square (RMS) aberrations 4.96 µm (5-mm pupil), and endothelial cell density (ECD) 2,830 cells/mm². A toric implantable collamer lens (TICL; 12.6 mm, −2.00 D / +6.00 D @145°) was implanted under intraoperative axis guidance. One month postoperatively, UDVA improved to 0.8 and BDVA to 1.0. Refraction stabilized at −1.50 × 50°, and RMS decreased to 1.64 µm. Anterior segment OCT and ultrasound biomicroscopy confirmed adequate vault (endothelium–ICL: 2,558 µm; ICL–IOL: 1,626 µm) and open iridocorneal angles (34°). The corneal graft and intraocular lens remained stable, with no signs of graft rejection, intraocular pressure elevation, or endothelial compromise during short-term follow-up.
Conclusion / Take home message
Off-label TICL implantation may offer effective refractive rehabilitation in well-selected pseudophakic eyes after PK, particularly when conventional optical strategies are contraindicated. Longer-term follow-up is necessary to confirm safety and rotational stability.