Effect of Corneal Incision Features on Corneal Endothelial Cell, Astigmatism, and Higher-Order Aberrations After Implantable Collamer Lens Implantation.

Purpose: This study evaluated the impact of clear corneal incision (CCI) morphology on corneal endothelial cell density (ECD), astigmatism, and higher-order aberrations (HOAs) following implantable collamer lens (ICL) implantation. Design: Prospective study. Methods: Sixty-five patients (65 eyes) undergoing ICL implantation were included. CCI characteristics were assessed with the AS-OCT CASIA 2, and HOAs were measured using the Pentacam. Corneal astigmatism changes were analyzed using Aplin's vector analysis. Results: The study divided the eyes into two groups: intact incision (29 eyes, with well-aligned wound architecture) and defective incision (36 eyes, with misaligned incision planes or endothelial gaps). At 3 months postoperatively, corneal thickness at the incision exit (CT-Ex) was significantly different between the groups (p = 0.038). The incision exit angle (Angle-Ex) also differed significantly at 1 month (p = 0.023) and 3 months (p = 0.022). The defective incision group showed increases in incision length (IL) and the distance from the entry incision to the center (Dis-En) between 1 and 3 months (p = 0.006 and p = 0.034, respectively). Both groups showed significant reductions in CT-Ex, CT-En, and Angle-Ex at 3 months. In the defective incision group, trefoil, quadrafoil, and spherical aberrations increased significantly (p < 0.05) while ECD decreased significantly (p < 0.05). Conclusions: Shorter IL and smaller exit angle during ICL surgery increase the risk of forming defective incisions, leading to more HOAs and greater ECD loss within the 3-month postoperative period.