Official ESCRS | European Society of Cataract & Refractive Surgeons


Small incision lenticule extraction (SMILE) vs implantable collamer lens (ICL) implantation for treatment of high myopia: a matched comparative study

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Session Details

Session Title: Small Incision Lenticule Extraction II

Session Date/Time: Monday 16/09/2019 | 16:30-18:00

Paper Time: 16:48

Venue: Free Paper Forum: Podium 3

First Author: : N.Luft GERMANY

Co Author(s): :    J. Siedlecki   V. Schmelter   M. Shajari   W. Mayer   S. Priglinger   M. Dirisamer              

Abstract Details


To compare the safety, efficacy and patient-reported quality of vision between SMILE and ICL implantation for the treatment of high myopia.


University Eye Hospital, Ludwig-Maximilians-University, Munich, Germany


This prospective, cross sectional study included 40 eyes of 20 patients that underwent SMILE (Carl Zeiss Meditec AG; Jena, Germany) and 40 eyes of 20 patients that received posterior chamber phakic refractive lens implantation (Visian Implantable Collamer Lens, ICL; STAAR Surgical, Inc.; Monrovia, CA, USA) for high myopia (≥-6.00D of manifest refraction spherical equivalent; MRSE) at least three months previously. Patients suitable for a 1:1 matched analysis were selected based on their mean preoperative MRSE and astigmatism, age and pupil size. The standardized and clinically validated Quality of Vision (QOV) questionnaire was employed to gauge patient-reported postoperative visual quality.


Preliminary results show that refractive accuracy was comparable between groups regarding residual MRSE (SMILE -0.22±0.36 vs. ICL -0.34±0.31D; p=0.08) and percentages of eyes within ±0.50D and ±1.00D (p=0.63). Patients after ICL implantation yielded superior levels of UDVA (-0.16±0.012 vs -0.09±0.11 logMAR; p<0.01). SMILE induced significantly more corneal higher order aberrations than ICL implantation (e.g. spherical aberration 0.222±0.155µm vs. 0.021±0.086µm, p<0.01). The character of subjectively perceived visual symptoms differed between groups with post-SMILE patients reporting more starbursts and fluctuations of vision while post-ICL patients reported significantly more halos (p<0.05).


Both SMILE and ICL implantation are safe methods for the correction of high myopia. Owing to the reduced induction of corneal higher order aberrations, ICL implantation may offer a superior efficacy profile in high myopic patients. The spectrum of subjectively perceived visual disturbances differs between the two refractive techniques and should be discussed with patients during preoperative counseling.

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