Vertical rotation of phakic intraocular lens to achieve optimal vaulting in a myopic eye

Optimal implantable collamer lens (ICL) sizing and normal postoperative ICL vault are important to avoid adverse events. Spherical phakic intraocular lens (PIOL) implantation was done for a case of both eye myopia. Both eyes had similar ocular biometry, hence the same size PIOL was ordered. The right eye had postoperatively, a high posterior vault of 2000 μ on POD1, which reduced to 1000 μ on POD2. Re-evaluation confirmed similar ocular and PIOL parameters in both eyes. The PIOL was rotated 90° to a vertical rotation after which a reduction in the vault from 1000 to 700 μ was achieved. Satisfactory refractive outcome and optimal vault were maintained during subsequent visits. The left eye course was uneventful.