PRK plus crosslinking to correct refractive error after phakic intraocular lens repeated rotation: Bioptics Xtra

Introduction: Phakic intraocular lens (IOL) surgery is generally considered safe; however, spontaneous IOL rotation can occur in some patients. Repeat spontaneous rotation of the IOL presents a significant challenge that requires careful management. Patient and Clinical Findings: A 30-year-old man underwent bilateral phakic IOL implantation for high myopia in the context of a borderline cornea, characterized by keratometric asymmetry and anterior elevation at the location of the thinnest corneal point. The IOLs experienced spontaneous rotation, which was initially managed by surgical repositioning. However, the IOLs rotated spontaneously again less than a week after the repositioning. Diagnosis, Intervention, and Outcomes: The patient underwent topography-guided photorefractive keratectomy (PRK) combined with accelerated crosslinking (30 mW/cm 2 for 90 seconds, totaling 2.7 J/cm 2 ) in both eyes. 6-month post-PRK Xtra, his uncorrected vision improved to 20/20 in the right eye and 20/25 in the left eye. The IOLs have remained stable in their final rotated positions. Conclusions: This is the first reported case, to the authors' knowledge, of using PRK Xtra to manage residual refractive error in a patient experiencing repeated spontaneous rotation of phakic IOLs. This technique is feasible and may serve as an alternative to IOL exchange. It has been named “Bioptics Xtra.”