Vertical implantable collamer lens (ICL) rotation for the management of high vault due to lens oversizing

Purpose: To describe the good outcome of implantable collamer lens (ICL) rotation to reduce post-operative vault. Methods: Retrospective analysis of case report. A 43-year-old woman had V4c EVO + myopic non-toric ICL implantation and post-operatively she presented with anisocoria and high vault. She underwent surgery to rotate the ICL 90 degrees to a vertical orientation. Results: We achieved a reduction in the vault from 1020 to 486 μm after vertical ICL rotation. Satisfactory refractive outcome and optimal vault were achieved and maintained during the period of follow-up. Conclusion: Optimal ICL sizing is important as too high vault/clearance is associated with problems such as angle closure glaucoma, pupil dilatation and anisocoria and too low vault/clearance to increased risk of cataract formation. Non-toric ICL rotation can be a simple surgical technique to deal with oversized lenses thus avoiding ICL exchange.