Comparison Of The Visual Outcomes And Optical Quality Of Small-Incision Lenticule Extraction And Toric Implantable Collamer Lens Implantation To Correct High Astigmatism

To compare six-month visual outcomes and optical quality after small-incision lenticule extraction (SMILE) and toric implantable collamer lens (TICL) implantation for high myopia astigmatism.

This is a prospective, non-randomized study conducted in the Eye and ENT Hospital, Fudan University, China

This was a prospective non-randomized study. Overall, 88 eyes of 88 patients with high astigmatism (≥2.00 D) were enrolled, comprising 42 and 46 eyes in the SMILE and TICL groups, respectively. Uncorrected visual acuity, best-corrected visual acuity, subjective manifest refraction, and higher-order aberrations (HOAs) were examined before and 6 months after surgery. The astigmatism outcomes were further analyzed using Alpins vector analysis.

The preoperative astigmatism was -3.20±0.58D in the SMILE group and -3.09±0.81D in the TICL group (P=0.50), and the postoperative astigmatism was -0.58 ± 0.39D and -0.72±0.41D (P=0.10) in the SMILE and TICL groups, respectively, at the 6-month visit. Surgically induced astigmatism, correction index, difference vector, the magnitude of error, and index of success were comparable between the two groups (P>0.05). The Alpins vector analysis indicated a significant difference in AofE between two groups (SMILE: 3.05º±2.98º, TICL: 4.70º±3.84º; P=0.03). Compared with the SMILE group, the TICL group exhibited significantly less HOAs at the 6-month follow-up including total HOAs, total coma, horizontal coma, vertical coma, and spherical aberrations.

Both SMILE and TICL showed satisfactory efficacy and safety in correcting high myopia astigmatism, whereas TICL induced fewer HOAs, leading to better postoperative visual quality.