Comparative study between implantable collamer lens implantation and refractive lens exchange in patients with high myopia

Background and aim While corneal refractive surgery has established visual outcomes, phakic intraocular lenses (PIOLs), such as the implantable collamer lens (ICL), offer a cornea-preserving alternative with high predictability. This study aimed to evaluate the visual outcomes, safety, and effectiveness of ICL implantation compared to refractive lens exchange (RLE) in patients with high myopia. Patients and methods In this prospective, comparative study, 20 eyes of 16 high myopic patients (aged 40–47 years) were enrolled. Group 1 (ICL) included 10 eyes of seven patients who underwent posterior chamber PIOL implantation. Group 2 (RLE) included 10 eyes of nine patients treated with RLE and injectable posterior chamber IOL implantation. Each patient was subjected to measuring intraocular pressure, retinal examination, fluorescein angiography, determining cycloplegic refraction, calculating uncorrected visual acuity, and best-corrected visual acuity, and using an IOL. Results Group 1 showed significantly better best-corrected visual acuity, deeper anterior chamber depth, and larger white-to-white corneal diameter than group 2 ( P <0.05). Axial length and IOL power were significantly lower in group 1. Uncorrected visual acuity at 1 week, 1 month, 3 months, and 6 months was significantly better in group 1. Intraocular pressure was temporarily higher in group 1 during the first postoperative week but normalized thereafter. Group 1 had a significantly lower preoperative spherical equivalent and showed better postoperative refractive stability at all follow-up visits. Conclusion ICL implantation provided superior visual outcomes, refractive stability, and anatomical compatibility in high myopia compared to RLE, supporting its effectiveness and safety in selected patients.