Implantable collamer lens combined with femtosecond laser-assisted arcuate keratotomy and toric implantable collamer lens for high myopia with moderate-to-low astigmatism corrections: a comparative study.

Abstract

Background: To compare clinical outcomes of implantable collamer lens (ICL) combined with femtosecond laser-assisted arcuate keratotomy (FSAK) and toric implantable collamer lens (TICL) for high myopia with moderate-to-low astigmatism corrections.

Methods: In this single-center, non-randomized, parallel-group study, patients with high myopia and moderate-to-low astigmatism (0.75D ~ 2.00D) received either ICL+FSAK or TICL treatment and underwent a 3-month postoperative follow-up. We compared the efficacy, safety, predictability, and stability between the two groups, along with outcomes including vector analysis of astigmatism, intraocular pressure (IOP), corneal endothelial cell density (ECD), vault, modulation transfer function (MTF) cutoff, Strehl ratio (SR), and objective scatter index (OSI).

Results: At three months postoperatively, median manifest astigmatism in ICL+FSAK group was - 0.25 diopter (D), similar to that in TICL group was - 0.25D (P = 0.774). At all timepoints, two groups were comparable in terms of uncorrected distance visual acuity, corrected distance visual acuity, manifest spherical equivalent, manifest astigmatism, efficacy index, safety index. At 1 day, 1 month, and 3 months postoperatively, median surgically induced astigmatism in ICL+FSAK group were 0.74 D, 0.79 D, and 0.82 D, smaller than those in TICL group (0.86 D, 0.99 D, and 1.01 D) (P < 0.05). Similarly, median correction index postoperatively were 0.69 and 0.75 in ICL+FSAK group, smaller than those in TICL group (0.82 and 0.84) at 1 month and 3 months (P < 0.05). At all timepoints, no significant differences in difference vector or absolute value of angle error occurred between two groups.Similar results also occurred in IOP, ECD, vault, MTF cutoff, SR, and OSI.

Conclusions: TICL resulted in higher SIA and CI compared to FSAK, but there was no significant difference in postoperative manifest astigmatism. Therefore, both methods are excellent choices for high myopia with moderate-to-low astigmatism.

Trial registration number: ChiCTR2400092267. The registration date is November 13, 2024.

Clinical trial registry: Chinese Clinical Trial Registry.