One-Year Clinical Outcomes of Implantable Collamer Lens Implantation for Myopic Regression After Laser Vision Correction

One-Year Clinical Outcomes of Implantable Collamer Lens Implantation for Myopic Regression After Laser Vision Correction | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article One-Year Clinical Outcomes of Implantable Collamer Lens Implantation for Myopic Regression After Laser Vision Correction Ji Youn Choi, Seung Eun Lee, Min Ho Kang, Dong Hui Lim, Byoung Woo Ko, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6962961/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 13 You are reading this latest preprint version Abstract This retrospective, observational case series aimed to evaluate the one-year outcomes of Implantable Collamer Lens (ICL, STAAR Surgical, Nidau, Switzerland) implantation for myopic regression following laser vision correction. We assessed patients who underwent ICL implantation to correct myopic regression after corneal refractive surgery. Visual and refractive outcomes, higher-order aberrations (HOAs), and endothelial cell counts were also evaluated. A total of 76 eyes from 40 patients with spherical equivalent ranging from − 4.50 to − 1.00 diopters (D) were included. At one year, A Snellen uncorrected distance visual acuity (UDVA) of 20/20 or better was achieved in 93% of the eyes, and no loss of corrected distance visual acuity (CDVA) was observed. The efficacy index (postoperative UDVA/preoperative CDVA) and safety index (postoperative CDVA/preoperative CDVA) were 1.07 and 1.08, respectively, and the mean spherical equivalent were − 0.19 ± 0.31 D. Additionally, 99% of eyes achieved spherical equivalent refractions within ± 1.00 D, and all eyes had residual astigmatism within 1.00 D. Keratometry, endothelial cell density, and HOAs exhibited no significant changes ( p > .05). According our experiences, ICL implantation is a safe, effective, and predictable treatment for correcting myopic regression after laser vision correction, and maintaining visual quality without increasing HOAs. Health sciences/Medical research/Outcomes research Physical sciences/Optics and photonics/Optical techniques Myopic regression ICL implantation One year Figures Figure 1 INTRODUCTION Over the past few decades, corneal refractive procedures, including photorefractive keratectomy (PRK), laser in situ keratomileusis (LASIK), and keratorefractive lenticule extraction (KLEx) have been performed worldwide. These procedures have allowed many individuals to reduce their dependence on glasses, significantly enhancing their quality of life and daily activities. 1 , 2 Laser vision correction (LVC) surgery has consistently demonstrated high efficacy and safety in terms of clinical outcomes, 3 – 5 but myopic regression, which may occur over time following surgery, can cause inconvenience in patients by necessitating the use of glasses. This regression results in the corneal tendency to return to its preoperative state, particularly in patients with high myopia. 6 , 7 In such cases, retreatment options, such as laser enhancement or implantable collamer lens (ICL) implantation, may be considered. However, laser enhancement poses potential risks, including postoperative corneal complications such as corneal ectasia and epithelial ingrowth, and is not suitable for eyes with insufficient residual corneal thickness. 8 Additionally, postoperative pain following LVC may deter patients from undergoing repeated laser ablation surgery. 9 , 10 ICL implantation offers a safer and structurally conservative alternative, for patients with limited residual stromal thickness. Several studies have reported the clinical outcomes of ICL implantation for myopic regression following previous LVC. 11 , 12 Additionally, a few case reports have documented the use of ICL to correct residual hyperopia, reporting safe and effective outcomes. 13 , 14 However, long-term outcomes in larger cohorts remain limited, making it difficult to draw generalized conclusions. This study aimed to evaluate the one-year clinical outcomes of ICL implantation, including higher-order aberrations (HOAs), in a substantial cohort of eyes with myopic regression following prior laser correction procedures. RESULTS Patient characteristics A total of 76 eyes of 40 patients were included in this study. Of these, 49 eyes of 26 patients had a history of PRK, whereas 27 eyes of 14 patients had undergone LASIK. The mean interval since prior LVC was 13.09 ± 3.80 years. The mean preoperative spherical equivalent (SE) was –2.43 ± 0.71 diopters (D), and the mean central corneal thickness was 455.80 ± 42.21 µm. Preoperative patient demographics and analyses based on surgery type are summarized in Table 1. The PRK group showed significantly thinner central corneal thickness and lower manifest refractive cylinder values than the LASIK group (both, p < .001). No significant differences were observed between the two groups in terms of mean keratometry, endothelial cell count, or SE. Visual outcomes At the one-year follow-up, an uncorrected distance visual acuity (UDVA) of 20/20 or better was achieved in 93% of the eyes, while a preoperative corrected distance visual acuity (CDVA) of 20/20 or better was obtained in 97% of the eyes on the Snellen scale (Figure. 1A). No preoperative CDVA values exceeding 20/20 were documented, accounting for 0.0% of this category. The calculated efficacy index was 1.07. Safety CDVA remained stable in 93% of the eyes, whereas 7% of the eyes showed an improvement of one or more lines (Figure. 1B). Importantly, none of the eyes experienced loss of one or more CDVA lines. The calculated safety index is 1.08. Within the first year of follow-up, three eyes required ICL exchange for higher power due to postoperative under-correction. No significant postoperative complications, such as ICL-related cataracts, elevated intraocular pressure, or endophthalmitis were observed throughout the follow-up examinations. Refractive outcomes The predictive ability of the procedure was evaluated by comparing the attempted and achieved SE refractions using a scatter plot (Figure. 1C). The analysis revealed a slope of 0.93 and a coefficient of determination ( R 2 ) of 0.97. In terms of refractive accuracy, 87% of eyes achieved SE refractions within ± 0.50 D of the target, and 99% were within ± 1.00 D (Figure. 1D). One year postoperatively, 92% and 100% of eyes had residual astigmatism within 0.50 D and 1.00 D respectively, compared to 70% and 96% of eyes preoperatively (Figure. 1E). All cases were implanted with non-toric ICL, and the refractive astigmatism correction is presumed to be the result of surgically induced astigmatism. Corneal changes and higher-order aberrations Table 2 shows the changes in corneal characteristics, including HOAs, following ICL implantation. As some patients missed Scheimpflug-based Pentacam examinations during follow-up, the analysis of HOAs included only 56 eyes from 29 patients. At one year postoperatively, there were no significant changes in mean keratometry, pachymetry, or endothelial cell count compared to the preoperative values. Similarly, no significant differences were observed between the preoperative and postoperative groups in terms of total HOA, spherical aberration, total coma, or total trefoil. DISCUSSIONS Few studies have evaluated the outcomes of ICL implantation in patients with LVC history. This study builds upon these findings and demonstrate that ICL implantation is a safe and effective option for treating myopic regression following primary LVC. Chung et al. reported the 3-month outcomes of ICL implantation in 30 eyes that had previously undergone PRK or LASIK. 12 In comparison, our study presents one-year results from a larger cohort. A UDVA of 20/20 or better was achieved in 93% of the eyes in our study, compared to 83% in the study by Chung et al. CDVA was maintained or improved in 100% of eyes in our study, whereas it was 97% in another study. SE refractions within ± 1.00 D of the target were achieved in 96% of the eyes in our study, compared to 100% in the other. Residual astigmatism within ± 1.00 D was reported in 99% of the eyes in our study, versus 97% in the other. The efficacy and safety indices were 1.07 and 1.08 respectively, further supporting the positive outcomes of ICL implantation in post-LVC eyes, especially for those unsuitable for laser enhancement due to insufficient residual stromal tissue. In addition to prior studies focused on phakic eyes, Alfonso et al. evaluated ICL implantation in pseudophakic eyes with various previous corneal surgeries, including LASIK, PRK, radial keratectomy, intrastromal corneal ring segments implantation, and keratoplasty 15 . The subgroup with prior excimer laser surgery in their study achieved high levels of predictability and showed safety indices comparable to our findings. Although their study involved pseudophakic eyes, the consistent outcomes across surgically altered corneas highlight the versatility of ICL implantation. These results align with our findings and further support its applicability in both phakic and pseudophakic eyes with previous corneal procedures. Importantly, this study showed no significant postoperative changes in mean keratometry or HOAs. Unlike laser enhancement procedures that tend to flatten the cornea and induce oblate changes, ICL implantation preserves the prolate shape of the cornea. 16 This offers an advantage in maintaining corneal biomechanical stability and minimizing HOAs. 17 – 20 The study findings suggest that ICL implantation for eyes with previous LVC may be a viable option, without increasing HOAs. Furthermore, none of the eyes showed elevated intraocular pressure during the follow-up examinations, nor was there any significant postoperative decrease in endothelial cell counts. A previous study by Chen et al. reported outcomes from 19 eyes over a mean follow-up of 39 months. 11 A mild myopic shift was observed after five years, which may be attributable to axial length elongation, age-related changes in the crystalline lens, or gradual corneal steepening from the early postoperative period to the final follow-up. 11 In contrast, our study had a relatively shorter follow-up and lacked data such as axial length measurements, limiting the ability to evaluate long-term refractive changes. This study has certain limitations. First, it was retrospective. Second, although the sample size was larger than that of previous studies on ICL implantation after LVC, it remained relatively small. Third, the absence of a comparison group, consisting of patients who underwent laser enhancement, limited the ability to interpret outcomes. Fourth, as this was not a longitudinal study, refractive stability from the early postoperative period to the one-year follow-up could not be assessed. In conclusion, ICL implantation in eyes with myopic regression after LVC demonstrated safe and effective results one year postoperatively, maintaining visual quality without increasing HOAs. Further long-term studies with larger cohorts are required to validate and expand upon these findings. METHODS Participants This retrospective observational study adhered to the guidelines outlined in the Declaration of Helsinki and Good Clinical Practice. Ethical approval was obtained from the Institutional Review Board of the Hanyang University Guri Hospital (IRB No. 2024-12-032-002). Given the retrospective nature of this study, the requirement for informed consent was waived. All patients underwent ICL implantation between July 2019 and August 2023 following a comprehensive ocular examination and detailed preoperative counseling with explanation of possible enhancement options. This study included 76 eyes from 40 patients who met the following inclusion criteria: CDVA of 20/30 or better; stable manifest refraction values for at least one year; no significant corneal abnormalities such as ectasia or severe dry eye; no history of ocular trauma; no preexisting ocular conditions such as retinal disorders, cataracts, glaucoma; and an endothelial cell density of > 2000 cells/mm². Patients whose predicted residual stromal thickness was less than 300 µm after laser enhancement were primarily included, to avoid the increased risk of postoperative ectasia after retreatment. Ocular measurements Ocular assessments included manifest refraction, UDVA, CDVA, slit-lamp examination, autorefraction, keratometry (KR-800 Auto Ref/Keratometer, Topcon, Tokyo, Japan), intraocular pressure measurement (CT-80; Topcon, Tokyo, Japan), fundoscopy (VISUCAM 524, Carl Zeiss Meditec, Jena, Germany), specular microscopy (SP-1P, Topcon, Tokyo, Japan), anterior chamber depth, central corneal thickness, HOAs, and corneal topography (Pentacam, OCULUS Optikgeräte GmbH, Wetzlar, Germany). All patients were evaluated preoperatively, and one year postoperatively. The efficacy index was calculated as the ratio of postoperative UDVA to preoperative CDVA. The safety index was estimated as the ratio of the postoperative CDVA to the preoperative CDVA. Surgical procedure On the day of surgery, 0.5% phenylephrine and 0.5% tropicamide (Mydrin-P; Santen Pharmaceutical, Osaka, Japan) were administered for mydriasis. Under anesthesia with 0.5% proparacaine hydrochloride ophthalmic solution (Alcaine; Alcon Laboratories, Inc., Fort Worth, TX, USA) supplemented with 0.5% intracameral lidocaine, the angle-to-angle distance was measured using a caliper to validate ICL size. A 3.0-mm incision was made superiorly for eyes with with-the-rule astigmatism and temporally for eyes with against-the-rule astigmatism or without any astigmatism, to minimize it. An ophthalmic viscosurgical device (1% sodium hyaluronate; Healon, Johnson & Johnson Vision, Jacksonville, FL, USA) was injected into the anterior chamber and a VICM5 ICL model (STAAR Surgical, Inc., Monrovia, CA) was inserted into the posterior chamber using an injector cartridge. After irrigation with a balanced salt solution. All surgeries were completed without any intraoperative complications. Patients were prescribed 1% prednisolone (Pred Forte, Allergan, Irvine, CA, USA) and 0.5% moxifloxacin (Vigamox, Alcon Laboratories, Inc., Fort Worth, TX, USA) four times daily for two weeks, followed by 0.1% fluorometholone (Fluorometholone, Daewoong Pharmaceutical, Seoul, South Korea) four times daily for another two weeks. The power and size of the implanted ICL were determined using a modified vertex formula provided by STAAR Surgical, targeting emmetropia. For patients aged ≥ 40 years, slight myopia (− 0.5 to − 1.0 D) was targeted in the non-dominant eye to account for presbyopia, as previously described 21 , 22 . Target refraction was individualized using contact lens simulation based on the patient’s age and visual needs. The entire list of 76 eyes can be found as Supplementary Table S1 . Statistical analysis Data were organized in a spreadsheet, and the normality of distributions was assessed using the Kolmogorov–Smirnov test. Depending on data distribution, preoperative and postoperative values were compared using paired t-tests or Wilcoxon signed-rank tests. Independent t -tests or Mann–Whitney U tests were used for comparisons between two groups. Categorical variables were analyzed using the chi-square test. All statistical analyses were conducted using SPSS for Windows (IBM Corp., Armonk, NY, USA), and statistical significance was set at p < 0.05. Declarations Acknowledgments: None. Author contributions: Conceptualization: Kim JH, Ko BW. Methodology: Kim JH, Ko BW. Validation: Kim JH, Ko BW, Kang MH, Lim DH. Formal analysis: Choi JY. Investigation: Choi JY, Lee SE. Data curation: Choi JY, Lee SE. Writing – original draft: Choi JY. Writing – review and editing: Kim JH, Ko BW, Kang MH, Lim DH. Visualization: Choi JY. Supervision: Kim JH. All authors have read and agreed to the published version of the manuscript. Competing interest: The authors declare no competing interests. Data availability Statement: The data presented in the study are available on request from the corresponding author. Funding: There are no financial conflicts of interest to disclose. References Ang, M., Gatinel, D., Reinstein, D. Z., Mertens, E., Alió Del Barrio, J. L. & Alió, J. L. Refractive surgery beyond 2020. Eye (Lond) 35 , 362-382 (2021). Sugar, A., Hood, C. T. & Mian, S. I. Patient-reported outcomes following LASIK: Quality of life in the PROWL studies. JAMA 317 , 204–205 (2017). Wen, D. et al. Postoperative efficacy, predictability, safety, and visual quality of laser corneal refractive surgery: A network meta-analysis. Am. J. Ophthalmol. 178 , 65–78 (2017). Reinstein, D. Z. et al. Long-term visual and refractive outcomes after LASIK for high myopia and astigmatism from −8.00 to −14.25 D. J. Refract. Surg. 32 , 290–297 (2016). Reinstein, D. Z. et al. Small incision lenticule extraction (SMILE) for the correction of high myopia with astigmatism. J. Refract. Surg. 38 , 262–271 (2022). Chayet, A. S. et al. Regression and its mechanisms after laser in situ keratomileusis in moderate and high myopia. Ophthalmology 105 , 1194–1199 (1998). Güell, J. L. & Muller, A. Laser in situ keratomileusis (LASIK) for myopia from −7 to −18 diopters. J. Refract. Surg. 12 , 222–228 (1996). Bower, K. S. & Woreta, F. Update on contraindications for laser-assisted in situ keratomileusis and photorefractive keratectomy. Curr. Opin. Ophthalmol. 25 , 251–257 (2014). Betz, J. et al. Ocular pain after refractive surgery: Interim analysis of frequency and risk factors. Ophthalmology 130 , 692–701 (2023). Sobas, E. M., Videla, S., Maldonado, M. J. & Pastor, J. C. Ocular pain and discomfort after advanced surface ablation: An ignored complaint. Clin. Ophthalmol. 9 , 1625–1632 (2015). Chen, X. et al. Implantable collamer lens for residual refractive error after corneal refractive surgery. Int. J. Ophthalmol. 9 , 1421–1426 (2016). Chung, B. et al. 3-month surgical outcomes of implantable collamer lens implantation for myopic regression after laser vision correction surgeries: A retrospective case series. BMC Ophthalmol. 21 , 397 (2021). Srinivasan, S., Drake, A. & Herzig, S. Early experience with implantable collamer lens in the management of hyperopia after radial keratotomy. Cornea 27 , 302–304 (2008). Kamiya, K., Shimizu, K. & Komatsu, M. Implantable collamer lens implantation and limbal relaxing incisions for the correction of hyperopic astigmatism after laser in situ keratomileusis. Cornea 29 , 99–101 (2010). Alfonso, J. F. et al. Implantable Collamer Lens® for management of pseudophakic ametropia in eyes with a spectrum of previous corneal surgery. J. Refract. Surg. 34 , 654–663 (2018). Hashemian, S. J. et al. Ocular higher-order aberrations changes after implantable collamer lens implantation for high myopic astigmatism. J. Curr. Ophthalmol. 30 , 136–141 (2018). Oshika, T. et al. Comparison of corneal wavefront aberrations after photorefractive keratectomy and laser in situ keratomileusis. Am. J. Ophthalmol. 127 , 1–7 (1999). Sekundo, W. et al. One-year refractive results, contrast sensitivity, high-order aberrations and complications after myopic small-incision lenticule extraction (ReLEx SMILE). Graefes Arch. Clin. Exp. Ophthalmol. 252 , 837–843 (2014). Zhou, C. et al. Comparison of visual quality after SMILE correction of low-to-moderate myopia in different optical zones. Int. Ophthalmol. 43 , 3623–3632 (2023). Seiler, T., Mrochen, M. & Kaemmerer, M. Operative correction of ocular aberrations to improve visual acuity. J. Refract. Surg. 16 , S619–S622 (2000). Kamiya, K. et al. Monovision by implantation of posterior chamber phakic intraocular lens with a central hole (Hole ICL) for early presbyopia. Sci. Rep. 7 , 11302 (2017). Igarashi, A. et al. Multicenter clinical outcomes of hole implantable collamer lens implantation in middle-aged patients. Sci. Rep. 12 , 4236 (2022). Tables Table 1. Baseline characteristics of eyes according to previous surgery types Types of previous surgery Total PRK LASIK p -value Eyes (patients) 76 (40) 49 (26) 27 (14) Age (years) 35.82 ± 4.45 [28, 52] 34.70 ± 3.98 [28, 42] 37.93 ± 4.47 [30, 52] .003* Sex (male/female) [%] 23 [30] / 53 [70] 17 [35] / 32 [65] 6 [22] / 21 [78] .257 Time interval after previous surgery (years) 13.28 ± 3.74 [6, 20] 12.75 ± 3.46 [8, 20] 14.22 ± 3.97 [6, 20] .085 Residual corneal thickness (µm) 455.80 ± 42.21 [364, 566] 442.67 ± 40.11 [364, 566] 479.63 ± 34.86 [427, 545] <.001* Mean keratometry (D) 38.83 ± 1.81 [34.38, 42.63] 38.74 ± 2.03 [34.38, 42.63] 38.99 ± 1.33 [36.75, 41.25] .530 Endothelial cell count (/mm 2 ) 2854.29 ± 331.68 [1921, 3359] 2873.37 ± 353.28 [1921, 3359] 2819.67 ± 285.13 [2289, 3341] .481 Anterior chamber depth (mm) 3.13 ± 0.21 [2.69, 3.50] 3.14 ± 0.22 [2.73, 3.50] 3.11 ± 0.20 [2.69, 3.42] .569 Manifest sphere (D) −2.20 ± 0.74 [−4.25, −0.50] −2.20 ± 0.66 [−3.50, −0.75] −2.20 ± 0.88 [−4.25, −0.50] .979 Manifest cylinder (D) −0.44 ± 0.40 [−1.50, 0.00] −0.31 ± 0.30 [−1.00, 0.00] −0.70 ± 0.47 [−1.50, 0.00] <.001* Manifest spherical equivalent (D) −2.43 ± 0.71 [−4.50, −1.00] −2.35 ± 0.65 [−3.50, −1.13] −2.56 ± 0.80 [−4.50, −1.00] .275 All values are expressed as mean ± standard deviation [range]. D, diopters; LASIK, laser in situ keratomileusis; PRK, photorefractive keratectomy; asterisks (*) indicate statistically significant differences ( p < 0.05). Table 2. Preoperative and one-year postoperative parameters measured in the eyes Characteristics Mean ± SD p- value* Preoperative Year 1 Central corneal thickness (µm) 455.80 ± 42.21 [364, 566] 457.29 ± 41.60 [370, 567] .952 Mean keratometry (D) 38.83 ± 1.83 [34.38, 42.63] 38.72 ± 1.82 [34.50, 42.88] .734 Endothelial cell count (/mm 2 ) 2854.29 ± 331.68 [1921, 3359] 2837.38 ± 332.49 [1948, 3952] .893 HOAs ( n =56, µm) Total HOA 1.06±0.56 1.08±0.57 .164 Spherical aberration 0.57±0.24 0.55±0.23 .193 Total coma 0.77±0.57 0.78±0.59 .585 Total trefoil 0.19±0.15 0.20±0.15 .071 All values are expressed as mean ± standard deviation [range]. D, diopters; HOAs: higher-order aberrations; asterisks (*) indicate statistically significant differences ( p < 0.05). Additional Declarations No competing interests reported. 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13:40:57","extension":"xml","order_by":7,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":64873,"visible":true,"origin":"","legend":"","description":"","filename":"08823b374d2f45998d27e1a6452157971structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-6962961/v1/0d4c019a6b9721160d8ac3fd.xml"},{"id":94663589,"identity":"ac338a0b-44f0-4fe6-aa3e-f5b73bd638d4","added_by":"auto","created_at":"2025-10-29 12:12:01","extension":"html","order_by":8,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":72604,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-6962961/v1/08cbd6691558a665f1043d94.html"},{"id":94663586,"identity":"d106a92d-9cb5-43a1-a02c-fc342d551d5f","added_by":"auto","created_at":"2025-10-29 12:12:01","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":305449,"visible":true,"origin":"","legend":"\u003cp\u003eStandard graphs for reporting refractive outcomes 1 year after Implantable Collamer Lens implantation in eyes with myopic regression after previous laser vision correction surgery. (A) Preoperative uncorrected distance visual acuity and postoperative uncorrected distance visual acuity. (B) Change in Snellen lines of corrected distance visual acuity after the procedure. (C) Attempts in relation to achieved spherical equivalent refraction. (D) Accuracy of postoperative spherical equivalent. (E) Preoperative and postoperative residual astigmatism. CDVA = corrected distance visual acuity; D = diopters; Postop = postoperative; Preop = preoperative; SD = standard deviation; UDVA = uncorrected distance visual acuity.\u003c/p\u003e","description":"","filename":"Figure1..png","url":"https://assets-eu.researchsquare.com/files/rs-6962961/v1/789097d419fe1356f726eb63.png"},{"id":94674035,"identity":"ebba6bac-0910-4f86-81c2-1db3e61d0fa4","added_by":"auto","created_at":"2025-10-29 13:42:21","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":865648,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6962961/v1/70c1c1c1-56ef-4add-b81f-fa619a636d2d.pdf"},{"id":94663580,"identity":"4ea3345e-c8f9-4470-a356-b26c3b2eff11","added_by":"auto","created_at":"2025-10-29 12:12:01","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":296514,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryMaterial.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6962961/v1/27deafd1bb0523bf43c37a97.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"One-Year Clinical Outcomes of Implantable Collamer Lens Implantation for Myopic Regression After Laser Vision Correction","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eOver the past few decades, corneal refractive procedures, including photorefractive keratectomy (PRK), laser in situ keratomileusis (LASIK), and keratorefractive lenticule extraction (KLEx) have been performed worldwide. These procedures have allowed many individuals to reduce their dependence on glasses, significantly enhancing their quality of life and daily activities.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e Laser vision correction (LVC) surgery has consistently demonstrated high efficacy and safety in terms of clinical outcomes,\u003csup\u003e\u003cspan additionalcitationids=\"CR4\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e but myopic regression, which may occur over time following surgery, can cause inconvenience in patients by necessitating the use of glasses. This regression results in the corneal tendency to return to its preoperative state, particularly in patients with high myopia.\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e In such cases, retreatment options, such as laser enhancement or implantable collamer lens (ICL) implantation, may be considered. However, laser enhancement poses potential risks, including postoperative corneal complications such as corneal ectasia and epithelial ingrowth, and is not suitable for eyes with insufficient residual corneal thickness.\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e Additionally, postoperative pain following LVC may deter patients from undergoing repeated laser ablation surgery. \u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e ICL implantation offers a safer and structurally conservative alternative, for patients with limited residual stromal thickness. Several studies have reported the clinical outcomes of ICL implantation for myopic regression following previous LVC. \u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e Additionally, a few case reports have documented the use of ICL to correct residual hyperopia, reporting safe and effective outcomes.\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e However, long-term outcomes in larger cohorts remain limited, making it difficult to draw generalized conclusions.\u003c/p\u003e\u003cp\u003eThis study aimed to evaluate the one-year clinical outcomes of ICL implantation, including higher-order aberrations (HOAs), in a substantial cohort of eyes with myopic regression following prior laser correction procedures.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003e\u003cstrong\u003ePatient characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 76 eyes of 40 patients were included in this study. Of these, 49 eyes of 26 patients had a history of PRK, whereas 27 eyes of 14 patients had undergone LASIK. The mean interval since prior LVC was 13.09 \u0026plusmn; 3.80 years. The mean preoperative spherical equivalent (SE) was \u0026ndash;2.43 \u0026plusmn; 0.71 diopters (D), and the mean central corneal thickness was 455.80 \u0026plusmn; 42.21 \u0026micro;m.\u003c/p\u003e\n\u003cp\u003ePreoperative patient demographics and analyses based on surgery type are summarized in Table 1. The PRK group showed significantly thinner central corneal thickness and lower manifest refractive cylinder values than the LASIK group (both,\u0026nbsp;\u003cem\u003ep\u003c/em\u003e \u0026lt; .001). No significant differences were observed between the two groups in terms of\u0026nbsp;mean keratometry, endothelial cell count, or SE.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eVisual outcomes\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAt the one-year follow-up, an uncorrected distance visual acuity (UDVA) of 20/20 or better was achieved in 93% of the eyes, while a preoperative corrected distance visual acuity (CDVA) of 20/20 or better was obtained in 97% of the eyes on the Snellen scale (Figure. 1A). No preoperative CDVA values exceeding 20/20 were documented, accounting for 0.0% of this category. The calculated efficacy index was 1.07.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSafety\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCDVA remained stable in 93% of the eyes, whereas 7% of the eyes showed an improvement of one or more lines (Figure. 1B). Importantly, none of the eyes experienced loss of one or more CDVA lines. The calculated safety index is 1.08. Within the first year of follow-up, three eyes required ICL exchange for higher power due to postoperative under-correction. No significant postoperative complications, such as ICL-related cataracts, elevated intraocular pressure, or endophthalmitis were observed throughout the follow-up examinations.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRefractive outcomes\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe predictive ability of the procedure was evaluated by comparing the attempted and achieved SE refractions using a scatter plot (Figure. 1C). The analysis revealed a slope of 0.93 and a coefficient of determination (\u003cem\u003eR\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e) of 0.97. In terms of refractive accuracy, 87% of eyes achieved SE refractions within \u0026plusmn; 0.50 D of the target, and 99% were within \u0026plusmn; 1.00 D (Figure. 1D). One year postoperatively, 92% and 100% of eyes had residual astigmatism within 0.50 D and 1.00 D respectively, compared to 70% and 96% of eyes preoperatively (Figure. 1E).\u0026nbsp;All cases were implanted with non-toric\u0026nbsp;ICL, and\u0026nbsp;the refractive astigmatism correction is presumed to be the result of surgically induced astigmatism.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCorneal changes and higher-order aberrations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable 2 shows the changes in corneal characteristics, including HOAs, following ICL implantation. As some patients missed Scheimpflug-based Pentacam examinations during follow-up, the analysis of HOAs included only 56 eyes from 29 patients. At one year postoperatively, there were no significant changes in mean keratometry, pachymetry, or endothelial cell count compared to the preoperative values. Similarly, no significant differences were observed between the preoperative and postoperative groups in terms of total HOA, spherical aberration, total coma, or total trefoil.\u0026nbsp;\u003c/p\u003e"},{"header":"DISCUSSIONS","content":"\u003cp\u003eFew studies have evaluated the outcomes of ICL implantation in patients with LVC history. This study builds upon these findings and demonstrate that ICL implantation is a safe and effective option for treating myopic regression following primary LVC.\u003c/p\u003e\u003cp\u003eChung et al. reported the 3-month outcomes of ICL implantation in 30 eyes that had previously undergone PRK or LASIK.\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e In comparison, our study presents one-year results from a larger cohort. A UDVA of 20/20 or better was achieved in 93% of the eyes in our study, compared to 83% in the study by Chung et al. CDVA was maintained or improved in 100% of eyes in our study, whereas it was 97% in another study. SE refractions within \u0026plusmn;\u0026thinsp;1.00 D of the target were achieved in 96% of the eyes in our study, compared to 100% in the other. Residual astigmatism within \u0026plusmn;\u0026thinsp;1.00 D was reported in 99% of the eyes in our study, versus 97% in the other. The efficacy and safety indices were 1.07 and 1.08 respectively, further supporting the positive outcomes of ICL implantation in post-LVC eyes, especially for those unsuitable for laser enhancement due to insufficient residual stromal tissue.\u003c/p\u003e\u003cp\u003eIn addition to prior studies focused on phakic eyes, Alfonso et al. evaluated ICL implantation in pseudophakic eyes with various previous corneal surgeries, including LASIK, PRK, radial keratectomy, intrastromal corneal ring segments implantation, and keratoplasty \u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e. The subgroup with prior excimer laser surgery in their study achieved high levels of predictability and showed safety indices comparable to our findings. Although their study involved pseudophakic eyes, the consistent outcomes across surgically altered corneas highlight the versatility of ICL implantation. These results align with our findings and further support its applicability in both phakic and pseudophakic eyes with previous corneal procedures.\u003c/p\u003e\u003cp\u003eImportantly, this study showed no significant postoperative changes in mean keratometry or HOAs. Unlike laser enhancement procedures that tend to flatten the cornea and induce oblate changes, ICL implantation preserves the prolate shape of the cornea.\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e This offers an advantage in maintaining corneal biomechanical stability and minimizing HOAs.\u003csup\u003e\u003cspan additionalcitationids=\"CR18 CR19\" citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e The study findings suggest that ICL implantation for eyes with previous LVC may be a viable option, without increasing HOAs. Furthermore, none of the eyes showed elevated intraocular pressure during the follow-up examinations, nor was there any significant postoperative decrease in endothelial cell counts.\u003c/p\u003e\u003cp\u003eA previous study by Chen et al. reported outcomes from 19 eyes over a mean follow-up of 39 months.\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e A mild myopic shift was observed after five years, which may be attributable to axial length elongation, age-related changes in the crystalline lens, or gradual corneal steepening from the early postoperative period to the final follow-up.\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e In contrast, our study had a relatively shorter follow-up and lacked data such as axial length measurements, limiting the ability to evaluate long-term refractive changes.\u003c/p\u003e\u003cp\u003eThis study has certain limitations. First, it was retrospective. Second, although the sample size was larger than that of previous studies on ICL implantation after LVC, it remained relatively small. Third, the absence of a comparison group, consisting of patients who underwent laser enhancement, limited the ability to interpret outcomes. Fourth, as this was not a longitudinal study, refractive stability from the early postoperative period to the one-year follow-up could not be assessed.\u003c/p\u003e\u003cp\u003eIn conclusion, ICL implantation in eyes with myopic regression after LVC demonstrated safe and effective results one year postoperatively, maintaining visual quality without increasing HOAs. Further long-term studies with larger cohorts are required to validate and expand upon these findings.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\u003ch2\u003eParticipants\u003c/h2\u003e\u003cp\u003e This retrospective observational study adhered to the guidelines outlined in the Declaration of Helsinki and Good Clinical Practice. Ethical approval was obtained from the Institutional Review Board of the Hanyang University Guri Hospital (IRB No. 2024-12-032-002). Given the retrospective nature of this study, the requirement for informed consent was waived. All patients underwent ICL implantation between July 2019 and August 2023 following a comprehensive ocular examination and detailed preoperative counseling with explanation of possible enhancement options. This study included 76 eyes from 40 patients who met the following inclusion criteria: CDVA of 20/30 or better; stable manifest refraction values for at least one year; no significant corneal abnormalities such as ectasia or severe dry eye; no history of ocular trauma; no preexisting ocular conditions such as retinal disorders, cataracts, glaucoma; and an endothelial cell density of \u0026gt;\u0026thinsp;2000 cells/mm\u0026sup2;. Patients whose predicted residual stromal thickness was less than 300 \u0026micro;m after laser enhancement were primarily included, to avoid the increased risk of postoperative ectasia after retreatment.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eOcular measurements\u003c/h2\u003e\u003cp\u003eOcular assessments included manifest refraction, UDVA, CDVA, slit-lamp examination, autorefraction, keratometry (KR-800 Auto Ref/Keratometer, Topcon, Tokyo, Japan), intraocular pressure measurement (CT-80; Topcon, Tokyo, Japan), fundoscopy (VISUCAM 524, Carl Zeiss Meditec, Jena, Germany), specular microscopy (SP-1P, Topcon, Tokyo, Japan), anterior chamber depth, central corneal thickness, HOAs, and corneal topography (Pentacam, OCULUS Optikger\u0026auml;te GmbH, Wetzlar, Germany).\u003c/p\u003e\u003cp\u003eAll patients were evaluated preoperatively, and one year postoperatively. The efficacy index was calculated as the ratio of postoperative UDVA to preoperative CDVA. The safety index was estimated as the ratio of the postoperative CDVA to the preoperative CDVA.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003eSurgical procedure\u003c/h2\u003e\u003cp\u003eOn the day of surgery, 0.5% phenylephrine and 0.5% tropicamide (Mydrin-P; Santen Pharmaceutical, Osaka, Japan) were administered for mydriasis. Under anesthesia with 0.5% proparacaine hydrochloride ophthalmic solution (Alcaine; Alcon Laboratories, Inc., Fort Worth, TX, USA) supplemented with 0.5% intracameral lidocaine, the angle-to-angle distance was measured using a caliper to validate ICL size. A 3.0-mm incision was made superiorly for eyes with with-the-rule astigmatism and temporally for eyes with against-the-rule astigmatism or without any astigmatism, to minimize it. An ophthalmic viscosurgical device (1% sodium hyaluronate; Healon, Johnson \u0026amp; Johnson Vision, Jacksonville, FL, USA) was injected into the anterior chamber and a VICM5 ICL model (STAAR Surgical, Inc., Monrovia, CA) was inserted into the posterior chamber using an injector cartridge. After irrigation with a balanced salt solution. All surgeries were completed without any intraoperative complications. Patients were prescribed 1% prednisolone (Pred Forte, Allergan, Irvine, CA, USA) and 0.5% moxifloxacin (Vigamox, Alcon Laboratories, Inc., Fort Worth, TX, USA) four times daily for two weeks, followed by 0.1% fluorometholone (Fluorometholone, Daewoong Pharmaceutical, Seoul, South Korea) four times daily for another two weeks. The power and size of the implanted ICL were determined using a modified vertex formula provided by STAAR Surgical, targeting emmetropia. For patients aged\u0026thinsp;\u0026ge;\u0026thinsp;40 years, slight myopia (\u0026minus;\u0026thinsp;0.5 to \u0026minus;\u0026thinsp;1.0 D) was targeted in the non-dominant eye to account for presbyopia, as previously described\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e. Target refraction was individualized using contact lens simulation based on the patient\u0026rsquo;s age and visual needs. The entire list of 76 eyes can be found as Supplementary Table \u003cspan refid=\"MOESM1\" class=\"InternalRef\"\u003eS1\u003c/span\u003e.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003eStatistical analysis\u003c/h2\u003e\u003cp\u003eData were organized in a spreadsheet, and the normality of distributions was assessed using the Kolmogorov\u0026ndash;Smirnov test. Depending on data distribution, preoperative and postoperative values were compared using paired t-tests or Wilcoxon signed-rank tests. Independent \u003cem\u003et\u003c/em\u003e-tests or Mann\u0026ndash;Whitney U tests were used for comparisons between two groups. Categorical variables were analyzed using the chi-square test. All statistical analyses were conducted using SPSS for Windows (IBM Corp., Armonk, NY, USA), and statistical significance was set at \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConceptualization: Kim JH, Ko BW. Methodology: Kim JH, Ko BW. Validation: Kim JH, Ko BW, Kang MH, Lim DH. Formal analysis: Choi JY. Investigation: Choi JY, Lee SE. Data curation: Choi JY, Lee SE. Writing \u0026ndash; original draft: Choi JY. Writing \u0026ndash; review and editing: Kim JH, Ko BW, Kang MH, Lim DH. Visualization: Choi JY. Supervision: Kim JH. All authors have read and agreed to the published version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interest:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability Statement:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data presented in the study are available on request from the corresponding author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere are no financial conflicts of interest to disclose.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAng, M., Gatinel, D., Reinstein, D. Z., Mertens, E., Ali\u0026oacute; Del Barrio, J. L. \u0026amp; Ali\u0026oacute;, J. L. Refractive surgery beyond 2020. \u003cem\u003eEye (Lond) \u003c/em\u003e\u003cstrong\u003e35\u003c/strong\u003e, 362-382 (2021).\u003c/li\u003e\n\u003cli\u003eSugar, A., Hood, C. T. \u0026amp; Mian, S. I. Patient-reported outcomes following LASIK: Quality of life in the PROWL studies. \u003cem\u003eJAMA\u003c/em\u003e \u003cstrong\u003e317\u003c/strong\u003e, 204\u0026ndash;205 (2017).\u003c/li\u003e\n\u003cli\u003eWen, D. et al. Postoperative efficacy, predictability, safety, and visual quality of laser corneal refractive surgery: A network meta-analysis. \u003cem\u003eAm. J. Ophthalmol.\u003c/em\u003e \u003cstrong\u003e178\u003c/strong\u003e, 65\u0026ndash;78 (2017).\u003c/li\u003e\n\u003cli\u003eReinstein, D. Z. et al. Long-term visual and refractive outcomes after LASIK for high myopia and astigmatism from \u0026minus;8.00 to \u0026minus;14.25 D. \u003cem\u003eJ. Refract. Surg.\u003c/em\u003e \u003cstrong\u003e32\u003c/strong\u003e, 290\u0026ndash;297 (2016).\u003c/li\u003e\n\u003cli\u003eReinstein, D. Z. et al. Small incision lenticule extraction (SMILE) for the correction of high myopia with astigmatism. \u003cem\u003eJ. Refract. Surg.\u003c/em\u003e \u003cstrong\u003e38\u003c/strong\u003e, 262\u0026ndash;271 (2022).\u003c/li\u003e\n\u003cli\u003eChayet, A. S. et al. Regression and its mechanisms after laser in situ keratomileusis in moderate and high myopia. \u003cem\u003eOphthalmology\u003c/em\u003e \u003cstrong\u003e105\u003c/strong\u003e, 1194\u0026ndash;1199 (1998).\u003c/li\u003e\n\u003cli\u003eG\u0026uuml;ell, J. L. \u0026amp; Muller, A. Laser in situ keratomileusis (LASIK) for myopia from \u0026minus;7 to \u0026minus;18 diopters. \u003cem\u003eJ. Refract. Surg.\u003c/em\u003e \u003cstrong\u003e12\u003c/strong\u003e, 222\u0026ndash;228 (1996).\u003c/li\u003e\n\u003cli\u003eBower, K. S. \u0026amp; Woreta, F. Update on contraindications for laser-assisted in situ keratomileusis and photorefractive keratectomy. \u003cem\u003eCurr. Opin. Ophthalmol.\u003c/em\u003e \u003cstrong\u003e25\u003c/strong\u003e, 251\u0026ndash;257 (2014).\u003c/li\u003e\n\u003cli\u003eBetz, J. et al. Ocular pain after refractive surgery: Interim analysis of frequency and risk factors. \u003cem\u003eOphthalmology\u003c/em\u003e \u003cstrong\u003e130\u003c/strong\u003e, 692\u0026ndash;701 (2023).\u003c/li\u003e\n\u003cli\u003eSobas, E. M., Videla, S., Maldonado, M. J. \u0026amp; Pastor, J. C. Ocular pain and discomfort after advanced surface ablation: An ignored complaint. \u003cem\u003eClin. Ophthalmol.\u003c/em\u003e \u003cstrong\u003e9\u003c/strong\u003e, 1625\u0026ndash;1632 (2015).\u003c/li\u003e\n\u003cli\u003eChen, X. et al. Implantable collamer lens for residual refractive error after corneal refractive surgery. \u003cem\u003eInt. J. Ophthalmol.\u003c/em\u003e \u003cstrong\u003e9\u003c/strong\u003e, 1421\u0026ndash;1426 (2016).\u003c/li\u003e\n\u003cli\u003eChung, B. et al. 3-month surgical outcomes of implantable collamer lens implantation for myopic regression after laser vision correction surgeries: A retrospective case series. \u003cem\u003eBMC Ophthalmol.\u003c/em\u003e \u003cstrong\u003e21\u003c/strong\u003e, 397 (2021).\u003c/li\u003e\n\u003cli\u003eSrinivasan, S., Drake, A. \u0026amp; Herzig, S. Early experience with implantable collamer lens in the management of hyperopia after radial keratotomy. \u003cem\u003eCornea\u003c/em\u003e \u003cstrong\u003e27\u003c/strong\u003e, 302\u0026ndash;304 (2008).\u003c/li\u003e\n\u003cli\u003eKamiya, K., Shimizu, K. \u0026amp; Komatsu, M. Implantable collamer lens implantation and limbal relaxing incisions for the correction of hyperopic astigmatism after laser in situ keratomileusis. \u003cem\u003eCornea\u003c/em\u003e \u003cstrong\u003e29\u003c/strong\u003e, 99\u0026ndash;101 (2010).\u003c/li\u003e\n\u003cli\u003eAlfonso, J. F. et al. Implantable Collamer Lens\u0026reg; for management of pseudophakic ametropia in eyes with a spectrum of previous corneal surgery. \u003cem\u003eJ. Refract. Surg.\u003c/em\u003e \u003cstrong\u003e34\u003c/strong\u003e, 654\u0026ndash;663 (2018).\u003c/li\u003e\n\u003cli\u003eHashemian, S. J. et al. Ocular higher-order aberrations changes after implantable collamer lens implantation for high myopic astigmatism. \u003cem\u003eJ. Curr. Ophthalmol.\u003c/em\u003e \u003cstrong\u003e30\u003c/strong\u003e, 136\u0026ndash;141 (2018).\u003c/li\u003e\n\u003cli\u003eOshika, T. et al. Comparison of corneal wavefront aberrations after photorefractive keratectomy and laser in situ keratomileusis. \u003cem\u003eAm. J. Ophthalmol.\u003c/em\u003e \u003cstrong\u003e127\u003c/strong\u003e, 1\u0026ndash;7 (1999).\u003c/li\u003e\n\u003cli\u003eSekundo, W. et al. One-year refractive results, contrast sensitivity, high-order aberrations and complications after myopic small-incision lenticule extraction (ReLEx SMILE). \u003cem\u003eGraefes Arch. Clin. Exp. Ophthalmol.\u003c/em\u003e \u003cstrong\u003e252\u003c/strong\u003e, 837\u0026ndash;843 (2014).\u003c/li\u003e\n\u003cli\u003eZhou, C. et al. Comparison of visual quality after SMILE correction of low-to-moderate myopia in different optical zones. \u003cem\u003eInt. Ophthalmol.\u003c/em\u003e \u003cstrong\u003e43\u003c/strong\u003e, 3623\u0026ndash;3632 (2023).\u003c/li\u003e\n\u003cli\u003eSeiler, T., Mrochen, M. \u0026amp; Kaemmerer, M. Operative correction of ocular aberrations to improve visual acuity. \u003cem\u003eJ. Refract. Surg.\u003c/em\u003e \u003cstrong\u003e16\u003c/strong\u003e, S619\u0026ndash;S622 (2000).\u003c/li\u003e\n\u003cli\u003eKamiya, K. et al. Monovision by implantation of posterior chamber phakic intraocular lens with a central hole (Hole ICL) for early presbyopia. \u003cem\u003eSci. Rep.\u003c/em\u003e \u003cstrong\u003e7\u003c/strong\u003e, 11302 (2017).\u003c/li\u003e\n\u003cli\u003eIgarashi, A. et al. Multicenter clinical outcomes of hole implantable collamer lens implantation in middle-aged patients. \u003cem\u003eSci. Rep.\u003c/em\u003e \u003cstrong\u003e12\u003c/strong\u003e, 4236 (2022).\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1. Baseline characteristics of eyes according to previous surgery types\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv align=\"\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"598\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTypes of previous surgery\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePRK\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLASIK\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003eEyes (patients)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e76 (40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e49 (26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e27 (14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003eAge (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e35.82 \u0026plusmn; 4.45 \u0026nbsp;\u003c/p\u003e\n \u003cp\u003e[28, 52]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e34.70 \u0026plusmn; 3.98\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e[28, 42]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e37.93 \u0026plusmn; 4.47 \u0026nbsp;\u003c/p\u003e\n \u003cp\u003e[30, 52]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e.003*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003eSex (male/female) [%]\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e23 [30] / 53 [70]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e17 [35] / 32 [65]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e6 [22] / 21 [78]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e.257\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003eTime interval after previous surgery (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e13.28 \u0026plusmn; 3.74 \u0026nbsp;\u003c/p\u003e\n \u003cp\u003e[6, 20]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e12.75 \u0026plusmn; 3.46\u003c/p\u003e\n \u003cp\u003e[8, 20]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e14.22 \u0026plusmn; 3.97\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e[6, 20]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e.085\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003eResidual corneal thickness (\u0026micro;m)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e455.80 \u0026plusmn; 42.21\u003c/p\u003e\n \u003cp\u003e[364, 566]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e442.67 \u0026plusmn; 40.11\u003c/p\u003e\n \u003cp\u003e[364, 566]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e479.63 \u0026plusmn; 34.86\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e[427, 545]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026lt;.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003eMean keratometry (D)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e38.83 \u0026plusmn; 1.81\u003c/p\u003e\n \u003cp\u003e[34.38, 42.63]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e38.74 \u0026plusmn; 2.03\u003c/p\u003e\n \u003cp\u003e[34.38, 42.63]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e38.99 \u0026plusmn; 1.33\u003c/p\u003e\n \u003cp\u003e[36.75, 41.25]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e.530\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003eEndothelial cell count (/mm\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e2854.29 \u0026plusmn; 331.68\u003c/p\u003e\n \u003cp\u003e[1921, 3359]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e2873.37 \u0026plusmn; 353.28\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e[1921, 3359]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e2819.67 \u0026plusmn;\u0026nbsp;285.13\u003c/p\u003e\n \u003cp\u003e[2289, 3341]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e.481\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003eAnterior chamber depth (mm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e3.13 \u0026plusmn; 0.21\u003c/p\u003e\n \u003cp\u003e[2.69, 3.50]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e3.14 \u0026plusmn; 0.22\u003c/p\u003e\n \u003cp\u003e[2.73, 3.50]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e3.11 \u0026plusmn; 0.20\u003c/p\u003e\n \u003cp\u003e[2.69, 3.42]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e.569\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003eManifest sphere (D)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u0026minus;2.20 \u0026plusmn; 0.74\u003c/p\u003e\n \u003cp\u003e[\u0026minus;4.25, \u0026minus;0.50]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e\u0026minus;2.20 \u0026plusmn; 0.66\u003c/p\u003e\n \u003cp\u003e[\u0026minus;3.50, \u0026minus;0.75]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e\u0026minus;2.20 \u0026plusmn; 0.88\u003c/p\u003e\n \u003cp\u003e[\u0026minus;4.25, \u0026minus;0.50]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e.979\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003eManifest cylinder (D)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u0026minus;0.44 \u0026plusmn; 0.40\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e[\u0026minus;1.50, 0.00]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e\u0026minus;0.31 \u0026plusmn; 0.30\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e[\u0026minus;1.00, 0.00]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e\u0026minus;0.70 \u0026plusmn; 0.47\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e[\u0026minus;1.50, 0.00]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026lt;.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003eManifest spherical equivalent (D)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u0026minus;2.43 \u0026plusmn; 0.71\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e[\u0026minus;4.50, \u0026minus;1.00]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e\u0026minus;2.35 \u0026plusmn; 0.65\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e[\u0026minus;3.50, \u0026minus;1.13]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e\u0026minus;2.56 \u0026plusmn; 0.80\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e[\u0026minus;4.50, \u0026minus;1.00]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e.275\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eAll values are expressed as mean \u0026plusmn; standard deviation [range]. D, diopters;\u003csup\u003e\u0026nbsp;\u003c/sup\u003eLASIK, laser in situ keratomileusis;\u003csup\u003e\u0026nbsp;\u003c/sup\u003ePRK, photorefractive keratectomy; asterisks (*) indicate statistically significant differences (\u003cem\u003ep\u003c/em\u003e \u0026lt; 0.05).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003c/strong\u003e\u003cstrong\u003eTable 2.\u003c/strong\u003e \u003cstrong\u003ePreoperative and one-year postoperative parameters measured in the eyes\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"604\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 242px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 278px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean \u0026plusmn; SD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep-\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003evalue*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 139px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePreoperative\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYear 1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 242px;\"\u003e\n \u003cp\u003eCentral corneal thickness (\u0026micro;m)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139px;\"\u003e\n \u003cp\u003e455.80 \u0026plusmn; 42.21\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e[364, 566]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139px;\"\u003e\n \u003cp\u003e457.29 \u0026plusmn; 41.60\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e[370, 567]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e.952\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 242px;\"\u003e\n \u003cp\u003eMean keratometry (D)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139px;\"\u003e\n \u003cp\u003e38.83 \u0026plusmn; 1.83\u003c/p\u003e\n \u003cp\u003e[34.38, 42.63]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139px;\"\u003e\n \u003cp\u003e38.72 \u0026plusmn; 1.82\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e[34.50, 42.88]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e.734\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 242px;\"\u003e\n \u003cp\u003eEndothelial cell count (/mm\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139px;\"\u003e\n \u003cp\u003e2854.29 \u0026plusmn; 331.68\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e[1921, 3359]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139px;\"\u003e\n \u003cp\u003e2837.38 \u0026plusmn; 332.49\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e[1948, 3952]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e.893\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 242px;\"\u003e\n \u003cp\u003eHOAs (\u003cem\u003en\u003c/em\u003e=56, \u0026micro;m)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 363px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 242px;\"\u003e\n \u003cp\u003eTotal HOA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139px;\"\u003e\n \u003cp\u003e1.06\u0026plusmn;0.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139px;\"\u003e\n \u003cp\u003e1.08\u0026plusmn;0.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e.164\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 242px;\"\u003e\n \u003cp\u003eSpherical aberration\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139px;\"\u003e\n \u003cp\u003e0.57\u0026plusmn;0.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139px;\"\u003e\n \u003cp\u003e0.55\u0026plusmn;0.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e.193\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 242px;\"\u003e\n \u003cp\u003eTotal coma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139px;\"\u003e\n \u003cp\u003e0.77\u0026plusmn;0.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139px;\"\u003e\n \u003cp\u003e0.78\u0026plusmn;0.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e.585\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 242px;\"\u003e\n \u003cp\u003eTotal trefoil\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139px;\"\u003e\n \u003cp\u003e0.19\u0026plusmn;0.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139px;\"\u003e\n \u003cp\u003e0.20\u0026plusmn;0.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e.071\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAll values are expressed as mean \u0026plusmn; standard deviation [range]. D, diopters; HOAs: higher-order aberrations; asterisks (*) indicate statistically significant differences (\u003cem\u003ep\u003c/em\u003e \u0026lt; 0.05).\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Myopic regression, ICL implantation, One year","lastPublishedDoi":"10.21203/rs.3.rs-6962961/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6962961/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eThis retrospective, observational case series aimed to evaluate the one-year outcomes of Implantable Collamer Lens (ICL, STAAR Surgical, Nidau, Switzerland) implantation for myopic regression following laser vision correction. We assessed patients who underwent ICL implantation to correct myopic regression after corneal refractive surgery. Visual and refractive outcomes, higher-order aberrations (HOAs), and endothelial cell counts were also evaluated. A total of 76 eyes from 40 patients with spherical equivalent ranging from \u0026minus;\u0026thinsp;4.50 to \u0026minus;\u0026thinsp;1.00 diopters (D) were included. At one year, A Snellen uncorrected distance visual acuity (UDVA) of 20/20 or better was achieved in 93% of the eyes, and no loss of corrected distance visual acuity (CDVA) was observed. The efficacy index (postoperative UDVA/preoperative CDVA) and safety index (postoperative CDVA/preoperative CDVA) were 1.07 and 1.08, respectively, and the mean spherical equivalent were \u0026minus;\u0026thinsp;0.19\u0026thinsp;\u0026plusmn;\u0026thinsp;0.31 D. Additionally, 99% of eyes achieved spherical equivalent refractions within \u0026plusmn;\u0026thinsp;1.00 D, and all eyes had residual astigmatism within 1.00 D. Keratometry, endothelial cell density, and HOAs exhibited no significant changes (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;.05). According our experiences, ICL implantation is a safe, effective, and predictable treatment for correcting myopic regression after laser vision correction, and maintaining visual quality without increasing HOAs.\u003c/p\u003e","manuscriptTitle":"One-Year Clinical Outcomes of Implantable Collamer Lens Implantation for Myopic Regression After Laser Vision Correction","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-29 12:11:57","doi":"10.21203/rs.3.rs-6962961/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-01-05T16:32:36+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-28T13:14:08+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"238677358805596282569243866811575445389","date":"2025-12-21T13:02:35+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-18T11:44:46+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"225506616863018671946704985101022746057","date":"2025-12-18T09:51:13+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-25T22:32:24+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"251012642154402081521388074801304293669","date":"2025-11-24T07:37:41+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"241996402394665739262013790925137148361","date":"2025-11-18T17:01:34+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-10-15T02:24:16+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-01T07:27:19+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-07-30T16:21:23+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-06-28T01:36:53+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2025-06-28T01:34:31+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"edcc0cd1-e44d-4807-96f1-2fd7393fb763","owner":[],"postedDate":"October 29th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[{"id":56852149,"name":"Health sciences/Medical research/Outcomes research"},{"id":56852150,"name":"Physical sciences/Optics and photonics/Optical techniques"}],"tags":[],"updatedAt":"2026-01-28T09:39:07+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-29 12:11:57","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6962961","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6962961","identity":"rs-6962961","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}