ICL versus SMILE in management of anisometropic myopic amblyopia in children

Abstract

Objective: We compare the predictability, safety, and efficacy of posterior chamber phakic intraocular lens (PCpIOL) versus small-incision lenticule extraction (SMILE) for correcting myopic anisometropia in amblyopic children.

Methods: A prospective randomized study enrolled 30 children, aged 4-12 years, with unilateral myopic anisometropic amblyopia whose refraction ranged between -5 and -10 diopters (D) and myopic astigmatic error -1 to -6 D. Patients were subdivided into group A for unilateral PCpIOL implantation and implantable collamer lens (Visian ICL/TICL) of V4C design and group B for SMILE procedure. Pre- and postoperative corrected distance visual acuity (CDVA), uncorrected visual acuity, and cycloplegic refractive spherical equivalent (CRSE) were performed in all patients and compared between both groups. Follow-up was for at least 18 months.

Results: Of the 15 children in group A, 12 (80%) revealed prevention of amblyopia and improvement in CDVA of 3-6 lines, and 3 children (20%) gained 1-3 lines. In group B, 6 (40%) eyes gained 3-5 lines, 6 (40%) eyes gained 1-3 lines, and 3 (20%) children gained 0-1 line. Stereoacuity improved in 93.33% of cases. Mean CRSE decreased in both groups 18 months postoperative (p < 0.001). Improvement in stereoacuity occurred in 86.66% of cases.

Conclusions: To eliminate significant anisometropic myopia in children who are noncompliant with conventional treatment, PCpIOL or SMILE may be considered as alternative modalities of treatment. Being an extraocular procedure, SMILE was found to be a safer procedure with fewer and less serious complications compared to ICL.