Four-year visual outcomes and optical quality of SMILE and implantable collamer lens V4c (EVO-ICL) implantation for high myopia: a retrospective study

Abstract

Background To compare the 4-year visual outcomes of implantable collamer lens V4c (EVO-ICL) implantation and small incision lenticule extraction (SMILE) for high myopia and astigmatism. Methods This retrospective case study included 64 eyes of 40 patients. These patients with preoperative manifest refraction spherical equivalent (SE) between − 6.00 and − 10.00 diopters (D) were screened from the database of SMILE and EVO-ICL implantation procedures in 2015. The ICL group [32 eyes of 19 patients (mean age, 29.6 ± 6.3 years); mean SE, -8.71 ± 1.06 D] and SMILE group [32 eyes of 21 patients (mean age, 27.7 ± 5.6 years); mean SE, -8.35 ± 0.65D] were compared. All patients were then prospectively examined at a four-year follow-up for routine postoperative examinations, higher-order ocular aberrations, retinal image quality and a questionnaire. Results The safety indexes were 1.15 ± 0.14 and 1.22 ± 0.21 (P = 0.36) for the SMILE and ICL groups, respectively. No eyes lost two or more lines of CDVA in either group. The efficacy indexes were 0.97 ± 0.16 and 0.96 ± 0.19 (P = 0.87), respectively. Twenty-three eyes (72%) in ICL and 26 eyes (81%) in SMILE groups were within ± 0.5 D of the attempted SE (P < 0.01). ICL-treated eyes had significantly less spherical aberration and coma (P < 0.01 and < 0.05, respectively) postoperatively. Halos were the prevalent visual disturbance in both groups. Conclusion SMILE and EVO-ICL implantation provided safe and effective correction of high myopia. SMILE showed slightly better long-term predictability. Mild postoperative visual disturbances were observed after ICL and SMILE at 4-year follow-up.

Comparative Analysis of Visual Outcomes and Complications in Intraocular Collamer Lens, Small-Incision Lenticule Extraction, and Laser-Assisted In Situ Keratomileusis Surgeries: A Comprehensive Review

“…In one study, the visual quality of ICL and SMILE procedures was compared, with findings indicating that ICL implantation demonstrated a significantly higher safety index than SMILE. At the same time, SMILE exhibited a slightly superior predictability profile [ 10 ]. Similarly, another study focused on outcomes for high myopia, revealing that ICL implantation resulted in better refractive accuracy, improved uncorrected distance visual acuity, fewer higher-order aberrations, and enhanced subjective quality of vision compared to SMILE [ 35 ].…”

“…Additionally, ICL was associated with lower induction of higher-order aberrations relative to SMILE. However, SMILE demonstrated a slightly superior predictability profile in this analysis [ 10 ]. Ultimately, the choice between ICL and SMILE hinges on individual factors, underscoring the importance of patients consulting with their eye care provider to determine the most suitable procedure for their needs [ 36 ].…”

“…Furthermore, the surgery is linked with a low incidence of significant cataract formation and excellent visual quality, particularly for individuals with high refractive prescriptions. Despite these benefits, it is crucial to consider potential risks and limitations, including careful patient selection, the possibility of postoperative visual disturbances, and the importance of ongoing monitoring and management of complications [8][9][10].…”