Purpose. To evaluate the safety, efficacy, and predictability of implantable collamer lens (ICL) implantation combined with a LenSx femtosecond laser-assisted limbal relaxing incision (LRI) for the correction of corneal astigmatism. Methods. This prospective study enrolled 64 eyes (54 patients) with high myopia with low to moderate regular corneal astigmatism. They were divided into an ICL group with ICL implantation (18 patients, 20 eyes), a TICL group with toric ICL implantation (17 patients, 23 eyes), and a LenSx + ICL group with a LenSx femtosecond laser-assisted LRI and an ICL implantation (19 patients, 21 eyes). Visual acuity, astigmatism correction ability, and visual quality were measured before and 1, 3, and 6 months after surgery. Results. The postoperative visual acuity of the 3 groups was higher than the preoperative visual acuity ( P < 0.01 ), and the improvements in the LenSx + ICL group and the TICL group were greater than those in the ICL group ( P < 0.01 ). The LenSx + ICL and TICL groups had less residual astigmatism and a higher astigmatism correction index (CI) than the ICL group ( P < 0.01 ). There was no significant difference among the three groups in total high-order aberrations (HOAs) before and after surgery ( P > 0.05 ). Conclusion. LenSx femtosecond laser-assisted LRI can effectively correct low to moderate corneal astigmatism during ICL implantation surgery. It can achieve similar clinical effects in the short term compared with TICL implantation.

Background The individualized ablation is not only able to correct corneal low-order aberrations but also improve the corneal high-order aberrations in corneal asymmetry patients. In this study, we compared the effect of patients with mid-to-high astigmatism asymmetric corneas (1-4D) after three different surgical methods: Selective coma guidance femtosecond Laser in-situ keratomileusis (CWFG-FS-LASIK),Aberration-Free femtosecond Laser in-situ keratomileusis (AF-FS-LASIK) and Small incision lenticule (SMILE).Methods One hundred and fourteen eyes from 58 patients were enrolled in the retrospective study. We measured and compared the best corrected visual acuity (BCVA), uncorrected visual acuity (UCVA), residual astigmatism, total coma, vertical coma (Z3-1), horizontal coma (Z31), Modulation Transfer Function (MTF) and Point Spread Function (PSF) at preoperation and postoperation after three months.Results Visual acuity of patients in three groups was increased after surgeries, but the improvements of visual acuity and residual astigmatism among them were no significant differences. However, the improvements of 4mm and 6mm total coma, Z3-1 and Z31 in CWFG-FS-LASIK were superior than in AF-FS-LASIK and SMILE. Consistent with this, the improvements of MTF and PSF (3mm and 5mm) in CWFG-FS-LASIK were better than in AF-FS-LASIK and SMILE.Conclusions In surgeries for treating patients with mid-to-high astigmatism in asymmetric corneas, the selective coma-guided mode was able to decrease the coma of original cornea, improve visual acuity and optimize the visual quality of patients.