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

## TL;DR

This study shows that the way a corneal incision is made during ICL surgery affects corneal cell density, astigmatism, and optical distortions three months after surgery.

## Contribution

The study identifies specific incision features linked to higher optical aberrations and endothelial cell loss after ICL implantation.

## Key findings

- Defective incisions led to increased higher-order aberrations and endothelial cell loss.
- Shorter incision length and smaller exit angle were associated with defective incisions.
- Corneal thickness and incision angles changed significantly over three months post-surgery.

## Abstract

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.

Prospective study.

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.

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).

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.