Comparison of Visual Outcomes and Optical Quality of Femtosecond Laser–Assisted SMILE and Visian Implantable Collamer Lens (ICL V4c) Implantation for Moderate to High Myopia: A Meta-analysis

PURPOSE: To compare visual outcomes and optical quality of femtosecond laser–assisted small incision lenticule extraction (SMILE) and Visian Implantable Collamer Lens (ICL V4c; STAAR Surgical) implantation for moderate to high myopia. METHODS: For this systematic review and meta-analysis, the Cochrane, PubMed, Embase, and Chinese databases (Wan-fang data and CNKI) were comprehensively searched to identify studies comparing SMILE and ICL V4c implantation. Data of interest were extracted and analyzed by Stata V.16.0 software (StataCorp). The weighted mean differences and their 95% confidence intervals were used to assess the strength of the association. RESULTS: Twelve studies incorporating 1,390 eyes of 822 patients were included. The analysis revealed ICL V4c implantation had a significantly higher safety index and lower high order aberrations, coma, and spherical aberration than SMILE in treating moderate to high myopia ( P < .05). Subgroup analysis revealed such differences were more prominent in patients with high myopia who had shorter follow-up duration. When follow-up was longer than 6 months, the differences in safety index and total HOAs became nonsignificant ( P > .05). The two procedures had no difference in efficacy index, postoperative visual acuity, spherical equivalent, trefoil, Objective Scatter Index, or modulation transfer function cut-off frequency ( P > .05). CONCLUSIONS: Both SMILE and ICL V4c implantation were safe and efficient for moderate to high myopia. Compared with SMILE, ICL V4c implantation might provide better postoperative visual quality in patients with high myopia in the early postoperative period. [ J Refract Surg . 2022;38(6):332–338.]