Refractive lens exchange with customized toric intraocular lenses in a young patient with posterior microphthalmos: A case report

Posterior microphthalmos (PM) is a rare developmental anomaly characterized by short axial length with normal anterior segment dimensions. Patients frequently experience high hyperopia and astigmatism, and while spectacles or contact lenses remain first-line management, these may cause cosmetic and functional limitations in young adults. We report the case of an adolescent male with PM who presented with significant hyperopia and social discomfort from high-plus spectacles. Following counselling on available options, refractive lens exchange (RLE) with customized intra-capsular toric intraocular lenses (IOLs) was performed sequentially in both eyes. Surgery was uneventful with appropriate intraoperative precautions, including mannitol infusion and retinal backup. At 15 months, the patient achieved stable refraction, good visual acuity, and satisfactory cosmetic outcomes. To our knowledge, this is among the first reports of customized toric IOL implantation for PM. We also propose a stepwise “stepladder” treatment algorithm to guide cosmetic rehabilitation in such patients.