Abstract
BACKGROUND: This study compared refractive outcomes and visual quality between femtosecond laser-assisted arcuate keratotomy (FSAK) and steep-axis meridian clear corneal incision (SCCI) combined with Implantable Collamer Lens (ICL) implantation for correcting moderate-to-high myopia and low astigmatism. METHODS: This prospective study included 28 eyes undergoing FSAK + ICL surgery and 31 undergoing SCCI + ICL surgery. The primary outcome was total corneal higher-order aberrations (HOAs) at 3 months postoperatively. HOA components, including spherical aberration, coma, and trefoil, were also analyzed as prespecified secondary visual-quality outcomes. Secondary outcomes included UDVA, CDVA, refraction (spherical equivalent and cylinder), astigmatism vector parameters, and corneal endothelial cell density, measured preoperatively and at 1 and 3 months postoperatively. RESULTS: Data are presented as mean ± standard deviation unless otherwise stated. Postoperative spherical equivalent (SE), UDVA, or CDVA were comparable between groups. At 3 months, the safety index was 1.14 ± 0.12 and 1.04 ± 0.51 (P = 0.344), and the efficacy index was 1.13 ± 0.22 and 1.03 ± 0.23 (P = 0.118) for the FSAK and SCCI groups, respectively. All eyes (100%) in both groups achieved ± 1.00 D of the expected corrected SE. Residual astigmatism was − 0.48 ± 0.26 D in the FSAK group and − 0.41 ± 0.27 D in the SCCI group, (P > 0.05). Total HOAs at 3 months were lower in the FSAK group than in the SCCI group (P = 0.039), with lower spherical and trefoil aberrations in the FSAK group (P < 0.05). Corneal endothelial cell density did not change significantly in the FSAK group (P > 0.05) but decreased significantly in the SCCI group at 3 months (P < 0.01). CONCLUSION: In this short-term follow-up, FSAK and SCCI combined with ICL implantation demonstrated good safety, efficacy, and predictability for correcting moderate-to-high myopia with low astigmatism. FSAK showed better early stability, fewer higher-order aberrations (including spherical and trefoil components), and superior corneal endothelium protection compared to SCCI.