PURPOSE: To compare the safety of the minimum ophthalmic viscosurgical device (OVD) technique with the standard procedure in phakic Visian Implantable Collamer Lens (ICL) (STAAR Surgical AG, Nidau, Switzerland) implantation. METHODS: This retrospective cohort study evaluated a total of 147 eyes of 74 patients who underwent ICL implantation with the minimum OVD technique (minimum OVD group) and 154 eyes of 77 patients with the standard procedure (standard OVD group). Intraoperative and postoperative complications were recorded. Preoperative and postoperative visual acuity, intraocular pressure (IOP), aqueous depth (AQD), and central corneal endothelial cell density (ECD) were collected and analyzed over the 12-month follow-up. Lens vault and occurrence of paracentesis after surgery were also recorded. RESULTS: No intraocular complications were observed. No difference was found in visual outcomes, lens vault, and AQD at all time points between the two groups ( P > .05). The minimum OVD group had significantly lower IOP than the standard OVD group at 2 hours (17.04 ± 4.21 vs 19.40 ± 6.78 mm Hg, P < .001) and 3 hours (15.12 ± 3.38 vs 17.15 ± 5.09 mm Hg, P < .001) postoperatively. The IOP gradually returned to the preoperative level after 24 hours postoperatively. The occurrence rate of paracentesis was significantly less in the minimum OVD group compared with the standard group (0.68% [1 of 147] vs 3.2% [5 of 154], P < .001). ECD was not significantly different between groups at all time points ( P > .05). CONCLUSIONS: The minimum OVD technique could achieve visual and structural outcomes comparable to the standard procedure without additional damage to the corneal endothelial cells, while reducing the IOP fluctuations after surgery. [ J Refract Surg. 2020;36(1):42–48.]

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Objective To evaluate possible differences in visual outcome and optical quality when small incision lenticule extraction (SMILE) versus implantable collamer lens (ICL) is used to correct myopia. Methods PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials were searched up to August 2021 to identify relevant studies. The PRISMA guidelines were followed. Primary outcomes were postoperative efficacy, safety, and predictability at the end of follow-up. Secondary outcomes were changes in modulation transfer function cutoff frequency (MTF cut−off), objective scatter index (OSI) values, total higher-order aberrations (HOAs), spherical aberrations, and coma aberrations. Results Seven studies with a total of 1296 eyes (SMILE: 731 eyes; TECXL: 565 eyes) were included. The ICL group had a better MTF cut−off ( P = 0.007) and less change in the proportion of HOAs ( P < 0.001), spherical aberrations ( P = 0.009), and coma ( P = 0.006) than the SMILE group. For the other outcomes, there were no statistically significant differences. Conclusions SMILE and ICL implantation are comparable in efficacy, safety, and predictability for correcting myopia. Larger studies with longer follow-up times are warranted to provide a better understanding of the benefits of SMILE and ICL implantation.