Spontaneous Rotation of Toric Implantable Collamer Lens (Toric IPCL) in a Post-traumatic myopic eye

Abstract

We present a case of toric implantable phakic contact lens (Toric IPCL) spontaneous rotation in a patient with myopic astigmatism. A 35 year male with a history of trauma in right eye underwent Toric IPCL implantation in same eye. Preoperative uncorrected visual acuity (UCVA) was 5/60 and 6/24 respectively, while best corrected visual acuity (BCVA) was 6/9 and 6/6 with -7.00D sph/ -3.00D cyl@70° and -1.00D sph/-1.00D cyl @135°. After implantation of toric IPCL his right eye achieved BCVA of 6/6 with -0.75D cyl@ 170°. After 2 weeks the patient presented with sudden decrease of vision in his right eye. His BCVA was 6/18 with correction of +1.00D sph/-4.00D cyl @50°. It was seen that the lens had rotated. We decided to reposition the Toric IPCL and after repositioning we obtained BCVA of 6/6 with correction of 0.75D cyl @140°. But again Toric IPCL rotated after 3 months and repositioning was done. This again happened after few weeks. So there were three episodes of Toric IPCL rotation. After discussing with patient we planned for Toric IPCL explantation and performed clear lens extraction with toric IOL implantation. Patient achieved UCVA of 6/6 and N6 with near addition of +2.50 D. TIPCL can present a considerable rotation that compromises visual acuity. The relocation of TIPCL is a safe and effective procedure to recover visual acuity due to significant spontaneous TIPCL rotation. In post traumatic eyes, the anterior chamber depth may be unpredictable and hence the chance of rotation of toric IPCL should be explained to the patient so as to avoid future issues.