Clinical Effects Observation of ICL Implantation With Personalized Surgically Induced Astigmatism for Correcting Low to Moderate Astigmatism With Myopia in Patients.

Objective: To evaluate the clinical effectiveness of personalized surgically induced astigmatism (SIA) combined with ICL implantation for correcting low to moderate astigmatism with myopia in patients.

Methods: A retrospective, noncomparative, noninterventional case series. The study included 55 myopic patients (87 eyes) with low to moderate astigmatism who underwent ICL implantation. All patients received a transparent corneal incision at the corneal steep axis, introducing personalized SIA. Preoperative and postoperative visual acuity, intraocular pressure (IOP), refractive diopter, corneal curvature, corneal astigmatism (CA), astigmatism axis, and aberrations were evaluated. Preoperative and postoperative data changes were analyzed, and CA vector analysis was performed.

Results: The uncorrected distance visual acuity (UDVA) at 1 week and 6 months postoperatively were similar to the preoperative corrected distance visual acuity (CDVA) (p1 = 0.870, p2 = 0.043), and better than the estimated corrected distance visual acuity (EsCDVA) (p1 < 0.001, p2 < 0.001). The postoperative UDVA remained stable over time (p=0.054). The ocular refractive astigmatism (RA) decreased by -0.43 D and approximately 51.81% (p < 0.001) at 1 w postoperatively, and by -0.32 D and approximately 38.55% (p < 0.001) at 6 m postoperatively. CA decreased by -0.38 D and approximately 30.65% (p < 0.001) at 1 w postoperatively, and by -0.27 D and approximately 21.77% (p < 0.001) at 6 m postoperatively. The postoperative regression in RA was approximately -0.11 D (p=0.011), and in CA, it was approximately -0.11 D (p=0.094). The postoperative total corneal aberrations and low-order aberration (LOA) were decreased (p < 0.05, p < 0.05), and high-order aberration (HOA) was increased (p < 0.05). As time progressed postoperatively, the corrective results tended to regress. The postoperative vertical coma was decreased (p > 0.05), and the horizontal coma and the spherical aberration were increased (p > 0.05, p > 0.05). As time progressed postoperatively, the postoperative variation tended to be obvious. The SIA values at 1 week and 6 months postoperatively were -0.41 D ∗ 89 (mean -0.52 D) and -0.28 D ∗ 88 (mean -0.42 D), the target induced astigmatism (TIA) values were -0.25 D ∗ 87 (mean -0.43 D) and -0.23 D ∗ 87 (mean -0.32 D), and the correlations between TIA and SIA were y = 0.44x + 0.33, R ² = 0.24 and y = 0.32x + 0.31, R ² = 0.19. The difference vector (DV) values were -0.16 D ∗ 2 (mean -0.50 D) and -0.05 D ∗ 4 (mean -0.41 D). The postoperative correction index (CI) values were all greater than 1, indicating mild overcorrection. Notably, the effect of overcorrection was more pronounced at 1 w postoperatively than 6 m. The index of success (IOS) values were 1.56 and 4.6.

Conclusion: ICL implantation with personalized SIA can achieve effective surgical outcomes for myopic patients with moderate to low astigmatism. However, as time progressed postoperatively, some corrective results tended to regress.