Rotational Stability After Implantation of Two Different Phakic Toric Intraocular Lenses

Abstract

Purpose: To compare clinical outcomes and rotational stability of the toric implantable Collamer lens (TICL) and toric implantable phakic contact lens (TIPCL). Methods: Charts were reviewed from January 2011 to January 2023 to identify all TICLs and TIPCLs implanted by a single surgeon. Implant size was generally chosen according to the manufacturer's recommendation, but 15 TIPCLs 0.25 mm larger than recommended to increase vaulting were included. Results: Eighty-four TICLs and 98 TIPCLs were identified and yielded excellent refractive and visual results in eyes with high myopic astigmatism at the last follow-up visit. No case of acute glaucoma or cataract induction was observed. In total, 15 (8.2%) rotated lenses were recorded; 2 (2.4%) TICLs and 13 (13.3%) TIPCLs ( P = .013). Eyes in both groups were similar in preoperative spherical equivalent, cylinder, white-to-white distance, anterior chamber depth (ACD), anterior chamber angle, and mean follow-up times ( P = .925, .673, .822, .794, .358, and .873, respectively). Average TICL size was larger than TIPCL size ( P < .001). Rotation of the lenses was positively correlated with cylinder and negatively correlated with ACD but not with vaulting ( P = .001, r = 0.253; P = .011, r = −0.193; P = .488, r = −0.057; respectively). Vaulting was positively correlated with preoperative ACD ( P ≤ .001, r = .329). In eyes with a rotated TIPCL, preoperative cylinder was higher and ACD was shallower than in eyes with a stable TIPCL ( P = .001 and .007, respectively). Increasing the implant size had no significant effect on rotation rate ( P = .685). Conclusions: Although both implants were safe and effective in highly myopic eyes, TICL rotated less frequently than TIPCL and required fewer secondary interventions. Rotation was correlated with preoperative cylinder and ACD but not lens vaulting. [ J Refract Surg . 2023;39(7):463–472.]