Postoperative Efficacy, Safety, Predictability, And Visual Quality Of Implantable Collamer Lens Implantation (Icl) Versus Small Incision Lenticule Extraction (Smile) In Moderate To Low Myopic Eyes

To compare the clinical efficacy, safety, and visual outcomes of Implantable Collamer Lens (ICL) and Small Incision Lenticule Extraction (SMILE) in treating low-to-moderate myopia.  

A retrospective study included 200 eyes from 100 patients with myopia ranging from -1.00 to -6.00 diopters (D). Patients were allocated into two groups: the ICL implantation group (n=100 eyes) and the SMILE group (n=100 eyes). 

Postoperative evaluations at 1, 3, 6, and 12 months assessed uncorrected visual acuity (UCVA), residual refractive error, higher-order aberrations (HOAs), and complication rates.

Both groups achieved significant improvements in UCVA, with 99% of ICL eyes and 96% of SMILE eyes achieving 20/20 or better at 12 months (p=0.31). The ICL group demonstrated superior efficacy in high-contrast vision stability at 6 months, with 92% of eyes within ±0.25D of the target refraction compared to 85% in the SMILE group (p=0.04).  Higher-order aberrations (HOAs) increased moderately in both groups, with SMILE inducing slightly more spherical aberration (p=0.03). Complication rates remained low for both procedures (ICL: 3.3% vs. SMILE: 5.0%, p=0.41), with transient dry eye observed in the SMILE group and asymptomatic vault changes noted in the ICL group.

ICL and SMILE are both effective for correcting low-to-moderate myopia. ICL provides slightly superior refractive predictability and stability,. The choice of surgical procedure should take into account individual corneal anatomy, lifestyle needs, and long-term ocular surface health.