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 keratorefractive lenticule extraction (KLEx) and EVO-implantable collamer lens (ICL) implantation for high myopia. SETTING: Eye & ENT Hospital of Fudan University, Shanghai, China. DESIGN: Retrospective study. METHODS: This study included 31 KLEx-treated patients (31 eyes, spherical equivalent: -7.62 ± 1.22 diopters [D]) and 32 ICL-treated patients (32 eyes, spherical equivalent: -8.22 ± 1.18 D). Refractive outcomes and objective visual quality were examined. Subjective visual quality was evaluated by a customized questionnaire. Patients' satisfaction was graded. RESULTS: 5 years postoperatively, the efficacy (KLEx: 0.96 ± 0.20; ICL: 1.03 ± 0.20; P = .164) and safety indices (KLEx: 1.12 ± 0.20; ICL: 1.21 ± 0.19; P = .067) were comparable. Statistically higher proportions of ICL-treated eyes achieved a postoperative uncorrected distance visual acuity of 20/20 or better ( P = .035). Refractive predictability was similar between the 2 groups ( P = .947), whereas more KLEx-treated eyes had myopic refractive errors ( P < .001). Total coma was significantly higher after KLEx ( P = .020), and greater total trefoil was observed after ICL implantation ( P = .006). Haloes were the primary visual disturbance in both groups (KLEx: 64.5%; ICL: 93.8%). The incidences of haloes ( P < .001), glare ( P = .004), and starbursts ( P = .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 = .894). CONCLUSIONS: For high myopia, EVO-ICL yielded better long-term refractive outcomes than KLEx. Haloes were the chief concern in both groups, with a significantly higher incidence after ICL implantation.