Three-Year Outcomes of Implantable Collamer Lens Followed by Excimer Laser Enhancement ("Bioptics") in the Treatment of High Myopic Astigmatism

Purpose: Describe three-year outcomes of spherical implantable Collamer lens (ICL) followed by excimer laser enhancement (bioptics) in eyes with high myopic astigmatism. Patients and Methods: Retrospective case series of thirty-four cases that underwent bioptics enhancement at the Johns Hopkins Wilmer Eye Institute. All eyes had a preoperative sphere of -6.00 D or more with a cylinder of at least 2.00 D. Uncorrected and corrected distance visual acuity (UDVA and CDVA), manifest spherical equivalent refraction (MSE), ICL vault measurements and central corneal thickness (CCT) were collected. Endothelial cell counts (ECC), root mean square (RMS) of higher order aberrations (HOAs), adverse events and subsequent surgeries were also assessed. Results: All patients had a minimum follow-up of 3 years. Preoperative UDVA was 2.29 +/- 0.46 logMAR and improved to 0.03 +/- 0.23 logMAR at 3 years (p<0.05). MSE was -12.30 +/- 4.05 preoperatively and changed to -0.21 +/- 0.46 at 3 years (p<0.05). The efficacy and safety indices were 1.28 +/- 0.32 and 1.47 +/- 0.27 at 3 years post-enhancement. HOA did not significantly change throughout the follow-up (p<0.05). Endothelial cell loss at 12 months was calculated at 5.7%. Two eyes required ICL exchange due to vault-related issues. Conclusion: Bioptics offered excellent long-term safe, predictable, and efficient outcomes for high myopic astigmatism and can be considered an option if toric ICL is not available. Results confirm that wavefront-guided photoablation remains an excellent option to manage residual refractive error after phakic IOL.