Anterior capsule breach during implantable collamer lens implantation: A four-year follow-up case report

Anterior capsular tears during phakic implantable collamer lens (ICL) implantation are rare but potentially serious. We report two highly myopic patients who developed small, localized anterior capsular tears in one eye during ICL delivery. With prompt conservative management using additional viscoelastic and Optical coherence tomography (OCT) guidance, the surgeons proceeded with ICL implantation in both cases. Over 4 years, both eyes maintained stable 20/20 uncorrected vision, normal intraocular pressure (IOP), preserved endothelial cell density, and no cataract or ICL decentration. These cases emphasize that proceeding with ICL implantation is feasible and safe when limited capsular tears are carefully managed.