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Aims: To compare the vault performance between implantable collamer lens (ICL) V4c and Toric ICL (TICL) V4c after implantation and to investigate the affecting factors., Methods: Sixty-eight eyes from 34 patients with myopia or myopia astigmatism who underwent implantation of TICL in one eye (group A) and identically sized ICL (group B) in the contralateral eye were included. Mean follow-up time were 7.58 ± 1.63 months (range: 6-10 months). Vault was compared between the two groups and correlations between vault and age, preoperative ocular biometric measurements were analysed. Generalized estimating equation (GEE) model of postoperative vault adjusting for within-patient intereye correlations was performed., Results: The safety indices were 1.27 and 1.35, and the efficacy indices were 1.20 and 1.24 for groups A and B, respectively. Vault of TICL was significantly higher than that of ICL (554.11 ± 219.36 μm vs 449.70 ± 172.47 μm, P < 0.001). The difference between ICL/TICL size and WTW (size-WTW) and STS (size-STS), anterior chamber depth and pupil diameter (PD) were positively correlated with vault. Patient age and clear lens rise measured by Pentacam were negatively correlated with vault. Results of GEE model showed preoperative PD, age, cylindrical power of TICL and size-WTW were influencing factors for postoperative vault., Conclusions: Vault after TICL implantation is higher than that with ICL. PD, age, cylindrical power of TICL and size-WTW could affect postoperative vault., (© 2020 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.)

Purpose: To evaluate the visual quality of myopic patients after non-toric versus toric implantable collamer lens (ICL and TICL, respectively) V4c, and to investigate the potential risk factors of postoperative night vision disturbances., Methods: This prospective cohort study included 42 eyes of 21 patients treated with ICL and 46 eyes of 23 patients treated with TICL. Refractive parameters and ocular aberrations were examined before and 6 months after surgery. Subjective quality of vision was scored by a validated questionnaire., Results: The efficacy index at 6 months was 1.14 ± 0.20 for ICL and 1.17 ± 0.16 for TICL; the safety index was 1.20 ± 0.17 for ICL and 1.20 ± 0.19 for TICL. The root mean square of total higher-order aberrations (HOAs) and trefoil was significantly increased, and no statistical differences between groups were detected in HOA changes. Many patients reported haloes (85.7% for ICL and 100% for TICL) and glare (76.2% for ICL and 65.2% for TICL), but most (94.4% for ICL and 95.5% for TICL) were satisfied or very satisfied with visual outcomes. Implantable collamer lens (ICL) toricity was the risk factor for frequency (OR = 2.81, p = 0.01), severity (OR = 3.85, p = 0.003) and bothering effect (OR = 2.89, p = 0.01) of haloes., Conclusions: Implantable collamer lens and TICL provided comparable efficacy, safety and predictability, induced acceptable level of HOAs and achieved high satisfaction in correcting myopia and myopic astigmatism. Although not severe, haloes and glare have a non-negligible prevalence and ICL toricity is a potential risk factor of haloes., (© 2020 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.)

Purpose: To compare visual outcomes and aberration outcomes in small incision lenticule extraction (SMILE) versus femtosecond laser LASIK (FS-LASIK)., Methods: This prospective, comparative, nonrandomized clinical study included 68 eyes of 37 patients receiving SMILE and 55 eyes of 30 patients receiving FS-LASIK between December 2011 and January 2013 at the Fudan University Eye and ENT Hospital (Shanghai, People's Republic of China). Patients were followed up at 3, 6 months and 5 years after surgery. Main outcome measurements included uncorrected (UDVA) and corrected (CDVA) distance visual acuity, manifest refraction, central corneal thickness (CCT), total corneal refractive power (TCRP) and wavefront aberrations., Results: About 98% (49/50) of treated eyes in the SMILE group and 95% (39/41) in the FS-LASIK group had a postoperative logMAR UDVA of 0 or better. Spherical equivalent (SE) after 5 years was -0.01 ± 0.35 D in the SMILE group and -0.23 ± 0.41 D in the FS-LASIK group. A regression of -0.02 ± 0.39 D in the SMILE group and -0.12 ± 0.32 D in the FS-LASIK group was observed between 6 months and 5 years postoperative time-points. TCRP increased by 0.39 ± 0.38 D in the SMILE group and 0.45 ± 0.49 D in the FS-LASIK group between 6-month and 5-year time-points. However, no statistically significant difference was found between the SMILE and FS-LASIK groups in terms of ∆SE, ∆CCT and ∆TCRP between 6 months and 5 years postoperative time-points., Conclusion: Myopic regression was observed in terms of TCRP but not in subjective refraction. No statistically significant difference in stability was found between SMILE and FS-LASIK., (© 2019 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.)

Purpose: To investigate early visual and refractive outcomes, corneal stability and optical quality after femtosecond laser small-incision lenticule extraction (SMILE) for treating myopia and myopic astigmatism over -10 D., Methods: Thirty eyes (30 patients) with myopia and myopic astigmatism of over -10 D were treated with VisuMax ® femtosecond laser (version 3.0; Carl Zeiss Meditec AG, Jena, Germany). Six months postoperative safety, efficacy and predictability were evaluated. Corneal Scheimpflug topography was measured preoperatively, 1 day, 3 months and 6 months postoperatively. Wavefront aberrations were measured preoperatively, 3 months and 6 months postoperatively., Results: Six months postoperatively, LogMAR uncorrected and corrected distance visual acuity (CDVA) were -0.013 ± 0.086 and -0.073 ± 0.069, respectively. 73% (97%) of eyes were within 0.5 (1) D of target refraction. No eyes lost CDVA, 43% (13 eyes) gained one line and 7% (two eyes) gained two lines. Mean corneal back curvature (KMB) and posterior central elevation (PCE) did not change significantly comparing preoperative and 6 months postoperative data (p = 0.91 and 0.77, respectively). Comparing 1 day with 6 months postoperative data, central corneal thickness (CCT), mean corneal front curvature (KMF), KMB and PCE did not change significantly (p = 0.27, 0.07, 0.52, 0.71, respectively). Total higher-order aberration (HOA), spherical aberration and coma increased significantly (p < 0.01) but trefoil remained stable (p = 0.49)., Conclusion: Our results indicate that SMILE can correct myopia and myopic astigmatism of over -10 D predictably. No early ectasia was observed. Long-term changes in visual quality and corneal stability require further investigation., (© 2017 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.)