{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,8]],"date-time":"2025-09-08T05:55:15Z","timestamp":1757310915636,"version":"3.40.5"},"reference-count":15,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","license":[{"start":{"date-parts":[[2023,11,16]],"date-time":"2023-11-16T00:00:00Z","timestamp":1700092800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["JCRS Online Case Rep"],"abstract":"<jats:sec>\n            <jats:title>Introduction:<\/jats:title>\n            <jats:p>This case reports the management of a bilateral toric implantable collamer lens (ICL) surgery with low vaulting and unilateral reduction in visual acuity (VA) associated with a combined effect of surgically induced astigmatism (SIA) and toric-ICL rotation. This case expands the common management of toric-ICL rotation, by adding surgically induced corneal changes.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Patient and Clinical Findings:<\/jats:title>\n            <jats:p>The patient presented with moderate myopia and high astigmatism and was implanted with a toric-ICL, resulting in bilateral low vault &lt;150 \u03bcm and unilateral VA reduction (20\/40) because of postoperative oblique astigmatism, observed at the 4-week follow-up.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Diagnosis, Intervention and Outcomes:<\/jats:title>\n            <jats:p>The low ICL vaulting was associated with a high crystalline lens rise and underestimation of the sulcus-to-sulcus distance. The VA reduction resulted from a combined effect of \u223c1.0 diopter SIA and 8-degree ICL rotation. The authors associate the high SIA to abnormal corneal biomechanics indexes and the toric-ICL rotation to a lack of stability resultant from a small ICL size. The left eye toric-ICL has exchanged with one with larger size and the power recalculated using vectorial analysis. The toric-ICL exchange increased the vault 75 \u03bcm and improved VA.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions:<\/jats:title>\n            <jats:p>Detailed anterior chamber morphometry and corneal biomechanics may assist in improving the refractive outcome in toric-ICL surgery.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1097\/j.jcro.0000000000000112","type":"journal-article","created":{"date-parts":[[2023,11,17]],"date-time":"2023-11-17T15:03:26Z","timestamp":1700233406000},"page":"e00112","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":1,"title":["Clinical management of a nonoptimal vault and unexpected postoperative refraction in a patient implanted with a phakic intraocular lens"],"prefix":"10.1097","volume":"12","author":[{"given":"Angel","family":"S\u00e1nchez-Tranc\u00f3n","sequence":"first","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7304-8756","authenticated-orcid":false,"given":"Ant\u00f3nio Manuel","family":"Baptista","sequence":"additional","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5808-7602","authenticated-orcid":false,"given":"Oscar Torrado","family":"Sierra","sequence":"additional","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0471-0213","authenticated-orcid":false,"given":"Pedro Miguel","family":"Serra","sequence":"additional","affiliation":[]}],"member":"276","published-online":{"date-parts":[[2024,1]]},"reference":[{"key":"R1-20241003","doi-asserted-by":"crossref","first-page":"e852","DOI":"10.1111\/aos.14720","article-title":"Consecutive contralateral comparison of toric and non-toric implantable collamer lenses V4c in vault after implantation for myopia and astigmatism","volume":"99","author":"Zhao","year":"2021","journal-title":"Acta Ophthalmol"},{"key":"R2-20241003","doi-asserted-by":"crossref","first-page":"1059","DOI":"10.2147\/OPTH.S111620","article-title":"Meta-analysis and review: effectiveness, safety, and central port design of the intraocular collamer lens","volume":"10","author":"Packer","year":"2016","journal-title":"Clin Ophthalmol"},{"key":"R3-20241003","doi-asserted-by":"crossref","first-page":"728","DOI":"10.1097\/j.jcrs.0000000000000146","article-title":"Determining vault size in implantable collamer lenses: preoperative anatomy and lens parameters","volume":"46","author":"Tranc\u00f3n","year":"2020","journal-title":"J Cataract Refract Surg"},{"key":"R4-20241003","doi-asserted-by":"crossref","first-page":"380","DOI":"10.3928\/1081597X-20200513-02","article-title":"Clinical prediction of excessive vault after implantable collamer lens implantation using ciliary body 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eye","volume":"98","author":"Fontana","year":"1980","journal-title":"Arch Ophthalmol"},{"key":"R8-20241003","doi-asserted-by":"crossref","first-page":"548","DOI":"10.3928\/1081597X-20150727-05","article-title":"Implantable collamer lens for myopia: assessment 12 years after implantation","volume":"31","author":"Moya","year":"2015","journal-title":"J Refract Surg"},{"key":"R9-20241003","doi-asserted-by":"crossref","first-page":"177","DOI":"10.3928\/1081597X-20190204-01","article-title":"Determining the potential role of crystalline lens rise in vaulting in posterior chamber phakic collamer lens surgery for correction of myopia","volume":"35","author":"Gonzalez-Lopez","year":"2019","journal-title":"J Refract Surg"},{"key":"R10-20241003","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1186\/s40662-021-00250-6","article-title":"Biometric and ICL-related risk factors associated to sub-optimal vaults in eyes implanted with implantable collamer lenses","volume":"8","author":"Cerpa Manito","year":"2021","journal-title":"Eye Vis (Lond)"},{"key":"R11-20241003","doi-asserted-by":"crossref","first-page":"617","DOI":"10.1016\/j.jcrs.2009.11.017","article-title":"Relationship between ciliary sulcus diameter and anterior chamber diameter and corneal diameter","volume":"36","author":"Kawamorita","year":"2010","journal-title":"J Cataract Refract Surg"},{"key":"R12-20241003","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1016\/j.ajo.2017.12.015","article-title":"Implantable collamer lens sizing method based on swept-source anterior segment optical coherence tomography","volume":"187","author":"Nakamura","year":"2018","journal-title":"Am J Ophthalmol"},{"key":"R13-20241003","doi-asserted-by":"crossref","first-page":"422","DOI":"10.5301\/ejo.5000575","article-title":"Effect of steep meridian clear corneal incisions in phacoemulsification","volume":"25","author":"Song","year":"2015","journal-title":"Eur J 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