ESCRS - FP30.13 - Three-Year Refraktiv And Visual Outcomes Of Keratorefractive Lenticule Extraction (Smile) And Implantable Collamer Lens (Icl) For Low Myopia.

Three-Year Refraktiv And Visual Outcomes Of Keratorefractive Lenticule Extraction (Smile) And Implantable Collamer Lens (Icl) For Low Myopia.

Published 2025 - 43rd Congress of the ESCRS

Reference: FP30.13 | Type: Free paper | DOI: 10.82333/0qbg-x237

Authors: Cemre Altas* ¹ , Wladislaw Rusch ¹ , Michael Steirat ¹ , Marcus Walckling ¹ , Thomas Fuchsluger ¹ , Tobias Brockmann ²

¹Ophthalmology ,University Medical Center Rostock,Rostock,Germany, ²Ophthalmology ,University Medical Center Rostock,Rostock,Germany;SciTec,University of Applied Sciences Jena,Jena,Germany

Purpose

Laser corneal procedures, such as LASIK and Small Incision Lenticule Extraction (SMILE), are the most common treatments for low myopia. Implantable Collamer Lens (i.e. ICL) implantation is typically considered when corneal conditions are unsuitable for laser ablation. This study compares the three-year outcomes of ICL implantation and SMILE for low myopia.

Setting

This study was conducted at a private, single-center eye clinic in Munich, Germany, specializing in refractive surgery. All procedures were performed by experienced refractive surgeons, including two surgeons for ICL implantation and three for SMILE. Strict inclusion criteria were applied to minimize confounding factors, excluding patients with corneal pathologies or a history of ocular surgeries.

Methods

A total of 5,852 eyes treated with SMILE and 2,489 eyes that underwent EVO+ ICL™ (Staar Surgical®) implantation were analyzed. One-to-one matching for sphere resulted in 211 eyes in each group. The preoperative sphere ranged from −0.50 to −3.50 diopters (D) in both groups (P = 0.9). The preoperative spherical equivalent ranged from −0.88 to −6.63 D in the ICL group and −0.75 to −4.75 D in the SMILE group. The ICL group included 160 patients (mean sphere/spherical equivalent: −2.7 ± 0.73 D / −3.6 ± 0.92 D), while the SMILE group included 152 patients (mean sphere/spherical equivalent: −2.8 ± 0.67 D / −3.2 ± 0.71 D). Postoperative data from routine examinations were retrospectively analyzed of all patients for up to three years.

Results

Postoperative examinations were conducted at 1 week, 6 weeks, 1 year, and 3 years. Uncorrected distance visual acuity (UCDVA) showed no significant difference between the groups (P = 0.2, 0.08, 0.08, and 0.2). In the ICL group, UCDVA was 0.9 ± 0.26 on the first day and stabilized at 1.0 ± 0.2 up to 3 years postoperatively. In the SMILE group, UCDVA was initially 0.8 ± 0.2, improved to 0.9 ± 0.2 at 1 week, reached 1.0 ± 0.17 at 4 weeks, and further improved to 1.1 ± 0.1 at both 1 and 3 years.

At 6 weeks, the spherical equivalent was 0.09 ± 0.3 D (ICL) and 0.04 ± 0.6 D (SMILE), with no significant difference (P = 0.8). The calculated study power of 0.84 confirms adequate statistical strength.

Conclusions

Both procedures demonstrated excellent efficacy, stability, and accuracy in correcting low myopia. While SMILE exhibited slightly better long-term predictability, it was associated with a longer visual recovery period compared to ICL implantation.