Comparison of long-term visual quality after keratorefractive lenticule extraction and implantable collamer lens V4c for high myopia

Purpose: To compare the long-term refractive outcomes and visual quality after KLEx and EVO-ICL implantation for high myopia. Setting: Eye & ENT Hospital of Fudan University, Shanghai, China. Design: A retrospective study. Methods: This study included 31 KLEx-treated patients (31 eyes, spherical equivalent: -7.62D ± 1.22) and 32 ICL-treated patients (32 eyes, spherical equivalent: -8.22D ± 1.18). Refractive outcomes and objective visual quality were examined. Subjective visual quality was evaluated by a customized questionnaire. Patients’ satisfaction was graded. Results: Five-year postoperatively, the efficacy (KLEx: 0.96 ± 0.20; ICL: 1.03 ± 0.20; P = 0.164) and safety indices (KLEx:1.12 ± 0.20; ICL: 1.21 ± 0.19; P = 0.067) were comparable. Statistically higher proportions of ICL-treated eyes achieved a postoperative UDVA of 20/20 or better ( P = 0.035). Refractive predictability was similar between the two groups ( P = 0.947), whereas more KLEx-treated eyes had myopic refractive errors ( P < 0.001). Total coma was significantly higher after KLEx ( P = 0.020), and greater total trefoil was observed after ICL implantation ( P = 0.006). Haloes were the primary visual disturbance in both groups (KLEx: 64.5%; ICL: 93.8%). The incidences of haloes ( P < 0.001), glare ( P = 0.004), and starbursts ( P = 0.043) were notably higher after ICL implantation. The patient’s satisfaction scores were similar (KLEx: 9.10 ± 1.27; ICL: 9.10 ± 1.27; P = 0.894). Conclusions: For high myopia, EVO-ICL yielded better long-term refractive outcomes than KLEx. Haloes were the chief complaint in both groups, with a significantly higher incidence after ICL implantation.