Abstract
Purpose: To compare safety, efficacy, stability, and predictability of implantable collamer lens (ICL) with femtosecond-laser in situ keratomileusis (FS-LASIK) or small incision lenticule extraction (SMILE) for the correction of moderate-to-high myopia/myopic astigmatism.
 Study design: We retrospectively collected data from patients with moderate-to-high myopia/myopic astigmatism (spherical equivalent [SE] ≥ −3.00 diopters [D]) who underwent ICL (48 eyes), FS-LASIK (36 eyes), or SMILE (86 eyes) at Hai Yen Eye Center from October 2016 to February 2018.
 Materials and methods: The Wilcoxon Mann-Whitney U test was used to compare pre- and postoperative patients’ characteristics of ICL with SMILE or FS-LASIK. Generalized linear models with unstructured correlation matrix and robust standard errors were used to analyze efficacy and safety indices; logistic regression was used for cylinder predictability.
 Results: After controlling for age, preoperative SE, and preoperative corrected distance visual acuity (pCDVA), SMILE had significantly lower safety indices (Coefficient = −0.04, 95% CI = −0.07–−0.01) and efficacy indices (Coefficient = −0.10, 95% CI = −0.20–−0.01) than did ICL, while FS-LASIK was not significantly different from ICL (Coefficient = −0.02, 95% CI = −0.06–0.02 and Coefficient = −0.01, 95% CI= −0.10–0.09, respectively). ICL SEswere stable over 12 months after surgery. However, in FS-LASIK and SMILE, SEs significantly decreased at 12 months compared with 6 months after surgery. The percentage of eyes that underwent FS-LASIK and had target SEs within ±0.5 D at 12 months was significantly lower than those that underwent ICL (OR = 0.14, 95% CI = 0.02–0.85), after controlling for age, preoperative SE, and pCDVA.
 Conclusion: For the correction of moderate-to-high myopia/myopic astigmatism, ICL seems to perform better than SMILE and FS-LASIK.
Highlights
Three main surgical options to treat refractive errors are corneal reshaping, lens replacement, and intraocular lens (IOL) implantation
E-mail: ly.tran@haiyeneyecare.com of eyes that underwent FS-LASIK and had target spherical equivalent (SE) within ±0.5 D at 12 months was significantly lower than those that underwent implantable collamer lens (ICL) (OR = 0.14, 95% CI = 0.02–0.85), after controlling for age, preoperative SE, and preoperative corrected distance visual acuity (pCDVA)
The final model showed that ICL had significantly better safety and efficacy indices than did small incision lenticule extraction (SMILE) over 12 months (Coefficient = −0.04, 95% CI = −0.07–−0.01 and Coefficient= −0.10, 95% CI= −0.20–−0.01, respectively), after controlling for age, preoperative SE, and preoperative corrected distance visual acuity (CDVA)
Summary
Three main surgical options to treat refractive errors are corneal reshaping, lens replacement, and intraocular lens (IOL) implantation. In femtosecond-laser in situ keratomileusis (FS-LASIK), the cornea is reshaped by using an excimer laser to ablate the corneal stroma. Small incision lenticule extraction (SMILE) is a flapless corneal refractive surgery. Instead of creating a flap, this procedure uses a femtosecond laser to create a lenticule inside the corneal stroma and a small incision through which a whole lenticule is extracted. The incision size in SMILE is approximately 2–3 mm, 7–10 times shorter than the incision used in FS-LASIK (20–22 mm).[1] Another option for correcting refractive errors is to implant a collamer lens between the crystalline lens and the iris. The STAAR Surgical Co. (Monrovia, CA, USA) Visian implantable collamer lens (ICL) is currently the only posterior-chamber phakic IOL approved for use in the United States.[2]
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