Toric-ICL shows better predictability and efficacy than FS-LASIK for myopia correction in patients with moderate to high myopia and astigmatism

doi:10.12122/j.issn.1673-4254.2025.06.01

Abstract

Abstract:

Objective To compare the efficacy of toric implantable collamer lens (Toric-ICL) and femtosecond laser-assisted in situ keratomileusis (FS-LASIK) for myopia correction in patients with moderate to high myopia complicated with astigmatism. Methods We retrospectively collected data from 64 patients (aged 18-42 years) with moderate to high myopia complicated with astigmatism (128 eyes) undergoing either Toric-ICL (28 patients/56 eyes) or FS-LASIK (36 patients/72 eyes) at our department between January, 2019 and December, 2020. The changes of uncorrected distance visual acuity (UCVA), spherical equivalent (SE), mean astigmatism correction index (CI), corneal endothelial cell density (ECD) and intraocular pressure (IOP) following the procedures were compared between the two groups. Results In FS-LASIK group, all the eyes (72/72) achieved an UCVA≥1.0, similar to the rate in Toric-ICL group (55/56 eyes; P=0.2374). The postoperative SE was also comparable between FS-LASIK and Toric-ICL groups [0.43±0.06 D (range: -1.0 to 1.50 D) vs 0.38±0.05 D (range: -0.75 to 1.00 D); P=0.56]. The mean astigmatism CI was significantly higher in FS-LASIK group than in Toric-ICL group (0.8561 vs 0.7176; P<0.0001), and 88.89% of the eyes in FS-LASIK group and 69.64% in Toric-ICL group had postoperative astigmatism ≤0.50 D. No significant changes were observed in postoperative corneal ECD in FS-LASIK group, whereas ECD decreased significantly after the procedure in Toric-ICL group (P=0.0057). The patients undergoing Toric-ICL exhibited no significant changes of postoperative IOP, but the patients receiving FS-LASIK had significantly reduced IOP after the procedure (P<0.001). Conclusion Although the patients included in Toric-ICL group had higher myopia and astigmatism, Toric-ICL still showed better predictability and efficacy for astigmatic correction in Toric-ICL group. Toric-ICL is an effective and safe equivalent of FS-LASIK for correcting moderate myopia but can be more advantageous for correcting high myopia with astigmatism.

Key words: toric implantable collamer lens, femtosecond laser-assisted in situ keratomileusis, myopia, astigmatism, treatment effect

Hongyang LI, Wenxiong LIAO, Peng LEI, Chunyuan YANG, Yanying LI, Liping XUE, Duo TAN, Sijing LIU, Yi WU, Meilan CHEN. Toric-ICL shows better predictability and efficacy than FS-LASIK for myopia correction in patients with moderate to high myopia and astigmatism[J]. Journal of Southern Medical University, 2025, 45(6): 1113-1121.

Figures/Tables 5

Fig.1 Refractive outcomes of the patients at 6 months after the operation. A， B： Distribution of uncorrected distance visual acuity （UDVA） 6 months after operation in the two groups. C： Changes of postoperative UDVA and preoperative CDVA. D： Distribution of postoperative spherical equivalent （SE） in the two groups. E， F： Attempted SE refractive change plotted against the achieved SE refractive change.

Fig.2 Astigmatism analysis of the patients after the operation. A， B： Target-induced astigmatic change plotted against the surgery-induced astigmatic change. C： Corrective index of astigmatism is 0.8561 in FS-LASIK group and 0.7176 in T-ICL group （P<0.0001）. D： Astigmatic distribution before and after operation in the two groups.

Fig.3 Double-angle plots of corneal astigmatism before and at 1 month and 6 months after the operation in FS-LASIK group （A） and Toric-ICL group （B）.

Fig.4 Changes in corneal endothelial cell density （A） and intraocular pressure （B） after the operation in the two groups. *P<0.05， **P<0.01， ***P<0.001， ****P<0.0001.

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