【In Press】Comparison of optical quality after implantable collamer lens implantation and wavefront-guided laser in-situ keratomileusis

AIM: To compare the optical quality after implantation of implantable collamer lens (ICL) and wavefront-guided laser in-situ keratomileusis (WG-LASIK).METHODS: The study included 40 eyes of 22 patients with myopia who accepted ICL implantation and 40 eyes of 20 patients with myopia who received WG-LASIK. Before surgery and three months after surgery, the objective scattering index (OSI), the values of modulation transfer function (MTF) cutoff frequency, Strehl ratio, and the optical quality analysis system (OQAS) values (OVs) were accessed. The higher order aberrations (HOAs) data including coma, trefoil, spherical, 2nd astigmatism and tetrafoil were also obtained. For patients with pupil size <6 mm, HOAs data were analyzed for 4mm-pupil diameter. For patients with pupil size ≥6 mm, HOAs data were calculated for 6mm-pupil diameter. Visual acuity, refraction, pupil size and intraocular pressures were also recorded.RESULTS: In both ICL and WG-LASIK group, significant improvements in visual acuities were found postoperatively, with a significant reduction in spherical equivalent (P<0.001). After the ICL implantation, the OSI decreased slightly from 2.34±1.92 to 2.24±1.18 with no statistical significance (P=0.62). While in WG-LASIK group, the OSI significantly increased from 0.68±0.43 preoperatively to 0.91±0.53 postoperatively (Wilcoxon Signed Ranks test, P<0.000). None of the mean MTF cutoff frequency, Strehl ratio, OVs showed statistically significant changes in both ICL and WG-LASIK groups. In the ICL group, there were no statistical differences in the total HOAs for either 4mm-pupil or 6mm-pupil. In the WG-LASIK group, the HOA parameters increased significantly at 4 mm-pupil. The total ocular HOAs, coma, spherical and 2nd astigmatism were 0.12±0.06, 0.06±0.03, 0.00±0.03, 0.02±0.01, respectively. After the operation, these values were increased into 0.16±0.07, 0.08±0.05, -0.04±0.04, 0.03±0.01 respectively (Wilcoxon Signed Ranks test, all P<0.05). At 6mm-pupil, the induction of total HOAs was not statistically significant in the WG-LASIK group. CONCLUSION: ICL implantation has a less disturbance to optical quality than WG-LASIK. The OQAS system is a valuable complementary measurement to the wavefront aberrometers in evaluating the optical quality.