Three-Month Ocular Surface and Dry-Eye Outcomes After Implantable Collamer Lens (ICL) Implantation versus Small-Incision Lenticule Extraction (SMILE): A Prospective Non-Randomized Comparative Cohort Study
Year: 2026
Type: article
Abstract: Purpose: To compare ocular surface and dry-eye parameters 3 months after implantable collamer lens (ICL) implantation vs small-incision lenticule extraction (SMILE). Patients and Methods: Right eyes of 98 patients with complete data (SMILE, n = 49; ICL, n = 49) were analyzed. Ocular Surface Disease Index (OSDI), non-invasive tear meniscus height (NITMH), non-invasive tear-film break-up time (NIBUT), ocular redness index (ORI), corneal fluorescein staining (CFS), refraction and visual acuity were measured before and 3 months after surgery. Between-group comparisons of change from baseline were the primary analysis. Sensitivity ANCOVA models adjusted for the corresponding baseline value, preoperative spherical equivalent refraction (SEQ), age, sex and surgeon; CFS was analyzed using binary logistic regression for any staining (CFS > 0). Results: ICL eyes were more myopic (preoperative SEQ -6.47 ± 2.16 vs -4.55 ± 1.27 D; P < 0.001); baseline dry-eye parameters were similar, although small differences in CDVA and IOP were present. At 3 months, uncorrected and corrected distance visual acuity were comparable (P = 0.300 and 0.498). Between-group comparisons of change from baseline showed no statistically significant difference for NIBUT (-0.22 s; 95% CI -3.10 to 2.67; P = 0.881), NITMH, ORI, CFS or OSDI. In the sensitivity analysis, the baseline-adjusted between-group difference in 3-month NIBUT was -1.68 s (95% CI -4.01 to 0.64; P = 0.153). The adjusted odds of any staining (CFS) tended to be lower in the ICL group, but the difference did not reach statistical significance (odds ratio 0.33; 95% CI 0.11-1.01; P = 0.052) and should be considered exploratory. Conclusion: In this non-randomized comparison of patients with clinically normal preoperative ocular surface who received standardized postoperative lubrication, no statistically significant between-group differences were detected for the primary tear-film outcome NIBUT or for NITMH, ORI or OSDI at 3 months. The lower odds of any corneal staining after ICL were exploratory and require further confirmation.
Source: Clinical ophthalmology
DOI: 10.2147/opth.s654384
Authors: Huiyi Du, Huiqing Zhang, Anqi Yuan, Lu Xiong
Institution: Aier Eye Hospital Group (China)
Language: English
Subfield: Ophthalmology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,320
OpenAlex ID: W7224773980