Vertically Oriented Phakic Intraocular Lens (Iol)

Myopia is a global epidemic, with an estimated prevalence of more than 28%. Phakic Intraocular Lens (IOL) implantation is a popular method of reducing spectacle dependence in these cases, especially in high myopia. While phakic IOLs are conventionally oriented horizontally after implantation, we would like to report a case of vertically oriented phakic IOL in both eyes.

Refractive surgery out-patient department (OPD) in a tertiary eye institute in southern India

A 24-year-old lady presented to our OPD with a complaint of blurring of vision in her left eye for distance since undergoing a phakic IOL implantation elsewhere 3 months back. Her best corrected visual acuity(BCVA) was 20/20 in both eyes with a subjective refractive error of -0.50D@90 in right eye and +1.00/-4.00@170 in the left eye respectively. On post dilated slit lamp examination, the phakic IOL in the right eye was seen to be oriented horizontally(Figure 1a and 1b) while the phakic IOL in the left eye was vertically oriented (Figure 2a and 2b). 2b). A Toric enhancement scan on iTrace was done which showed that the IOL in the right eye was fairly well oriented, while the IOL in the left eye was oriented 90° away from the desired axis (Figure 3a and 3b). The patient was informed of the orientation of the IOL and was advised IOL repositioning to correct the refractive error. Subsequently, the patient achieved a uncorrected visual acuity of 6/6 in the left eye with a minimal refractive error of -0.50@175.

A popular phakic IOL used in southeast Asia is called implantable phakic contact lens (IPCL, Care Group, India). The IPCL has been marketed as a “smart Toric” lens, where the lenses are manufactured with toricity along the desired axis and are implanted horizontally to get the desired toric refractive error correction. This was a case of smart Toric IPCL which had been implanted along the wrong axis inducing a cylindrical error equal to the error requiring correction. This case highlights the ease and simplicity of correcting residual errors following phakic IOL implantation as opposed to laser refractive surgery, as well as the utility of iTrace in identifying the correct axis of orientation in toric lenses.