Comparison of Persistent Postoperative Discomfort 1 Year after Keratorefractive Lenticule Extraction and Implantable Collamer Lens Implantation

Purpose: To compare the prevalence and characteristics of persistent postoperative discomfort 1 year after keratorefractive lenticule extraction (KLEX) and implantable collamer lens (ICL) implantation. Methods: This retrospective comparative study included 324 eyes from 324 patients with myopia or myopic astigmatism who underwent bilateral KLEX (n = 227) or ICL implantation (n = 97) at a single center. One year postoperatively, visual outcomes, patient satisfaction, and persistent discomfort symptoms were evaluated using a standardized questionnaire, including symptom frequency, severity, and resolution time. Results: Visual outcomes and overall satisfaction were high and comparable between the two groups (97.3% for KLEX vs. 99.0% for ICL; p = 0.157). Persistent glare and halos were significantly less frequent in the KLEX group than in the ICL group (glare: 50.2% vs. 64.9%, p = 0.045; halos: 48.9% vs. 63.9%, p = 0.034). The time to resolution for these symptoms was significantly shorter in the KLEX group (p = 0.031 and p = 0.024, respectively). In contrast, dryness was more frequent, severe, and bothersome in the KLEX group than in the ICL group (all p < 0.001), and its resolution time was longer (p = 0.008). Conclusions: KLEX and ICL implantation showed distinct profiles of persistent postoperative discomfort at 1 year. ICL implantation was associated with higher rates and longer duration of glare and halos, while KLEX was associated with more severe and persistent dryness. These findings underscore the importance of individualized preoperative counseling and patient selection.