Short-term comparative outcomes of toric ICL implantation versus femtosecond LASIK for myopic astigmatism

To compare visual and refractive outcomes, predictability, safety, and efficacy of toric implantable collamer lens (TICL) implantation versus femtosecond laser-assisted in situ keratomileusis (FS-LASIK) in patients with moderate-to-high myopic astigmatism. Instituto de Ojos Oftalmosalud, Lima, Peru. Retrospective comparative cohort study. Consecutive eyes undergoing TICL or FS-LASIK were assessed at baseline and 3 months. Outcomes included UDVA/CDVA, spherical equivalent (SE), refractive cylinder, safety/efficacy indices, and vectorial astigmatism analysis. Double-angle plots depicted scalar magnitude/axis distributions. Non-parametric tests were used ( p < 0.05). 149 eyes (74 TICL, 75 FS-LASIK) were analyzed. Postoperative UDVA was better with FS-LASIK (0.04 ± 0.08 vs. 0.14 ± 0.16 LogMAR; p < 0.001), with no CDVA difference ( p = 0.178). FS-LASIK showed higher efficacy (1.09 ± 0.18 vs. 0.86 ± 0.23; p < 0.001) and more eyes within ± 0.50 D of emmetropia (72% vs. 53%; p < 0.001). Cylinder reduction favored FS-LASIK (–2.67 ± 0.75 vs. − 2.28 ± 1.14 D; p < 0.001). Alpins analysis: TICL—TIA 2.91 ± 1.19 D @90°, SIA 2.28 ± 1.14 D @93°, CI 0.77 ± 0.19, DV 1.72 ± 1.57 D, ME − 0.62 ± 0.56 D, AE − 2.65°±24.8°; FS-LASIK—TIA 2.86 ± 0.79 D @89°, SIA 2.67 ± 0.74 D @88°, CI 0.94 ± 0.09, DV 0.34 ± 0.49 D, ME − 0.18 ± 0.28 D, AE − 0.95°±3.83°. FS-LASIK had significantly lower DV and CI closer to 1.0 (both p < 0.001). Double-Angle plots confirmed smaller postoperative ellipses and centroid residuals with FS-LASIK (0.05 D @173°) than with TICL (0.44 D @97°). Complications were infrequent in both groups. In this selected non-randomized retrospective cohort, both TICL implantation and FS-LASIK provided effective short-term visual and refractive outcomes at 3 months. FS-LASIK showed better short-term uncorrected visual acuity, predictability, and astigmatic precision, whereas TICL remained a valuable option for eyes with higher refractive error, thin corneas, or contraindications to corneal ablation. Because treatment allocation was non-random, baseline myopia was greater in the TICL group, and follow-up was limited to 3 months, these findings should be interpreted cautiously and should not be extrapolated to long-term efficacy, safety, refractive stability, TICL rotational behavior, vault-related changes, or corneal stability.