BackgroundAnterior subcapsular cataract (ASC) is a leading complication of implantable collamer lens (ICL) implantation and a common indication for secondary ICL removal. However, the visual outcomes of combined ICL explantation, cataract extraction, and implantation of a TECNIS Symfony ZXR00 IOL with a targeted myopic shift (-0.50D to -0.75D) remain uncertain in highly myopic patients with prior ICL and photorefractive keratectomy (PRK) surgeries.Case presentationA 39-year-old male highly myopic patient who underwent concurrent ICL removal, phacoemulsification, and TECNIS Symfony ZXR00 IOL implantation in both eyes, spaced two weeks apart, is reported in this case. Surgical planning prioritized spectacle independence, occupational visual needs, and the IOL's optical properties, with a deliberate residual myopic refraction (-0.50D to -0.75D). At the 3-month follow-up, comprehensive evaluation was conducted, included manifest refraction, anterior segment OCT (Casia2), defocus curves, OPD-Scan III, and the NEI-VFQ-14 questionnaire. The patient achieved excellent near and intermediate vision, high overall optical quality, and reported exceptional satisfaction.ConclusionFor patients developing ASC post-ICL implantation, particularly those with strong preferences for spectacle independence and specific visual demands, the TECNIS Symfony ZXR00 IOL, combined with optimized residual myopia, may provide outstanding visual performance and patient satisfaction.