Efficacy and safety of implantable phakic contact lens vs implantable collamer lens in myopic eyes: systematic review and meta-analysis

TOPIC: To compare the efficacy and safety of implantable phakic contact lens (IPCL) vs implantable collamer lens (ICL) implantation for myopia correction. CLINICAL RELEVANCE: ICL is an established treatment for moderate-to-high myopia. However, comparative evidence evaluating outcomes between ICL and IPCL remains limited. METHODS: Following PRISMA 2020 guidelines (PROSPERO CRD420251207282), PubMed, Embase, and the Cochrane were searched through November 7, 2025, for studies comparing IPCL and EVO ICL implantation in myopic eyes. Primary outcomes were uncorrected (UDVA) and corrected distance visual acuity (CDVA), and spherical equivalent (SE). Secondary outcomes included refractive accuracy, vault, adverse events, and efficacy and safety indices. Random-effects models were used. RESULTS: 9 studies (3 randomized and 6 observational) including 1187 eyes (559 IPCL and 628 ICL) were analyzed. UDVA and CDVA were similar between groups. A small statistical difference in SE favored IPCL (mean difference -0.06 diopters [D]; 95% CI -0.11 to -0.00; P = .03), although this was not robust to sensitivity analysis. Refractive accuracy was similar (83% vs 88% within ±0.50 D; risk ratio [RR] 0.96; P = .21). Secondary outcomes were comparable, including out-of-range vault, cataract formation (0.7% vs 0.8%), endothelial cell loss (2.2% in both groups), and explantation. Acute glaucoma was rare (0.17%), occurring only with IPCL V1.0. Toric ICL demonstrated greater rotational stability (7.1% vs 1.8%; RR 3.49; P = .03). Efficacy and safety indices were comparable (IPCL: 1.05/1.19 vs ICL: 1.06/1.18). CONCLUSIONS: IPCL and ICL provide comparable visual and safety outcomes for myopia correction. Toric ICL showed greater rotational stability. Further long-term studies are warranted.