Comparison of the Toric Implantable Collamer Lens and Bioptics for Myopic Astigmatism

PURPOSE: To compare results between toric implantable collamer lens (TICL) implantation and bioptics (ICL and excimer laser ablation) for the correction of myopic astigmatism. METHODS: A retrospective evaluation was performed in 29 eyes (20 patients) with TICL implantation and 26 eyes (17 patients) treated with bioptics. For eyes treated with bioptics, corneal ablation was performed at 1.5 to 5 months (mean 2.56 months) after ICL implantation by laser epithelial keratomileusis in 17 eyes, LASIK in 8 eyes, and photorefractive keratectomy in 1 eye. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity, refraction, adverse events, safety, and efficacy were assessed preoperatively and 1, 6, and 12 months postoperatively. RESULTS: At 1 month postoperatively, UDVA in the TICL group was significantly higher than in the bioptics group (P=.02). However, the difference in UDVA at 12 months was not significant. At 12 months, mean spherical equivalent refraction was 0.33 +/- 0.21 diopters (D) in the TICL group and 0.29 +/- 0.41 D in the bioptics group (P=.07). Mean astigmatic error was higher in the TICL group (-0.42 +/- 0.32 D) than in the bioptics group (-0.32 +/- 0.38 D) (P=.10). In the bioptics group, the mean refractive cylinder at 12 months decreased from that reported at 6 months because of retreatment performed in two eyes. Safety and efficacy were not statistically different between groups. One eye with a TICL was treated to correct TICL decentration. Two crystalline lens opacities were observed after bioptics. CONCLUSIONS: This study demonstrates that TICL implantation provides reliable visual outcomes similar to bioptics. The advantages of TICL implantation are a more stable visual outcome and the elimination of laser treatments and their inherent risks. [J Refract Surg. 2011; 27(2): 91-97.] doi: 10.3928/1081597X-20100414-01