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Meta-Analysis
. 2021 Dec 27;21(1):450.
doi: 10.1186/s12886-021-02206-9.

Implantable collamer lens versus small incision lenticule extraction for high myopia correction: A systematic review and meta-analysis

Kai Cao  1 , Jingshang Zhang  1 , Jinda Wang  1 , Mayinuer Yusufu  1 , Shanshan Jin  1 , Shuying Chen  1 , Ningli Wang  1 , Zi-Bing Jin  1 , Xiu Hua Wan  2
Affiliations
Meta-Analysis

Implantable collamer lens versus small incision lenticule extraction for high myopia correction: A systematic review and meta-analysis

Kai Cao et al. BMC Ophthalmol. .

Abstract

Purpose: To compare the efficacy, safety, predictability and visual quality between implantable collamer lens (ICL) implantation and small incision lenticule extraction (SMILE) for high myopia correction in adults.

Methods: A systematic review and meta-analysis was conducted. A comprehensive literature search was done based on databases including PubMed, Science Direct, Embase, and the Cochrane Central Register of Controlled Trials. The efficacy index, safety index, changes in Snellen lines of corrected distance visual acuity (CDVA), predictability (difference between post-operative and attempted spherical equivalent error, SER), incidence of halos, and change in higher-order aberrations (HOAs) were compared. Mean difference (MD) and 95% confidence interval (CI) was used to estimate continuous outcomes, risk ratio (RR) and 95%CI was used to estimate categorical outcomes.

Results: Five observational studies involving 555 eyes were included in this review. Studies' sample sizes (eyes) ranged from 76 to 197. Subjects' refraction ranged from -6 diopter (D) to -12D. Study duration of most researches were 6 months or 12 months. Compared to SMILE, ICL implantation showed better efficacy index (MD=0.09, 95%CI:0.01 to 0.16) and better safety index (MD=0.08, 95%CI: 0.00 to 0.16). Compared with SMILE, more ICL-treated eyes gained one or more Snellen lines of CDVA (RR=1.54, 95%CI:1.28 to 1.86), more gained two or more lines (RR=2.09, 95%CI:1.40 to 3.13), less lost one or more lines (RR=0.17, 95%CI:0.05 to 0.63). There was no difference in predictability between two treatments, RRs of predictability of within ±0.5D and ±1D were 1.13 (95%CI: 0.94 to 1.36) and 1.00 (95%CI: 0.98 to 1.02). Compared with SMILE, ICL implantation came with a higher risk of halos [RR=1.79, 95%CI: 1.48 to 2.16] and less increase in total HOAs (MD=-0.23, 95%CI: -0.42 to -0.03).

Conclusion: Compared with SMILE, ICL implantation showed a higher risk of halos, but equal performance on SER control, and better performance on efficacy index, safety index, CDVA improvement and HOAs control. Overall, ICL implantation might be a better choice for high myopia correction in adults.

Keywords: Implantable collamer lens; Intraocular lens; high myopia; small incision lenticule extraction.

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Conflict of interest statement

There is no conflict of interest.

Figures

Fig. 1
Fig. 1
Flow chart of paper selection
Fig. 2
Fig. 2
Forest plot of comparison on efficacy index and safety index
Fig. 3
Fig. 3
Forest plot of comparison on gaining or loss of corrected distance visual acuity (A: gaining one or more lines, B: gaining two or more lines, C: losing one or more lines, D: losing two or more lines)
Fig. 4
Fig. 4
Forest plot of comparison on predictability
Fig. 5
Fig. 5
Forest plot of comparison on halos
Fig. 6
Fig. 6
Forest plot of comparison on total higher-order aberrations
See this image and copyright information in PMC

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