Vertical–horizontal rotation of EVO-ICL to correct suboptimal vault based on vertically oval sulcus anatomy

BackgroundBecause the ciliary sulcus is vertically oval and only a limited range of EVO Implantable Collamer Lens (ICL) sizes is available, suboptimal vault is sometimes unavoidable. This study evaluated whether a simple 90-degree vertical-horizontal rotation of non-toric ICLs can correct low or high vault without changing lens size.MethodsThis retrospective case series included consecutive eyes with suboptimal vault after primary implantation of non-toric ICL at a single refractive surgery center. Eyes with low vault underwent rotation from vertical to horizontal orientation, and eyes with high vault underwent rotation from horizontal to vertical. The primary outcome was the change in central vault; secondary outcomes included the proportion of eyes within a target vault of 250-750 µm, changes in refraction, IOP, and angle parameters.ResultsFifteen eyes from 11 patients were included (7 low-vault with vertical to horizontal, 8 high-vault with horizontal to vertical). In the low-vault group, mean vault increased from 106.57 to 324.86 µm (P < 0.001), with eyes in the target range increasing from 0% to 85.7% (P = 0.031). In the high-vault group, mean vault decreased from 946.88 to 561.38 µm (P < 0.001), and eyes in the target range increased from 0% to 100.0% (P = 0.016). Visual acuity, refraction, IOP, and angle parameters were generally stable, and no complications occurred.ConclusionsIn eyes with suboptimal vault after non-toric ICL implantation, 90-degree vertical-horizontal rotation can predictably move vault into a safer range without changing lens size and may be considered as a minimally invasive option before planning ICL exchange in selected cases.