Abstract: Objective To evaluate the changes in higher-order aberrations (HOAs) under a 4.00 mm pupil diameter after implantation of implantable collamer lens (ICL V4c). Design Retrospective case series. Participants From August to December 2022, 42 patients (84 eyes) aged 19 to 45 years with myopia underwent implantation of ICL V4c at Beijing Tongren Hospital. Methods HOAs were measured in a dark room environment with a 4.00 mm natural pupil diameter, both preoperatively and one month postoperatively using the iTrace visual analyzer. The changes of the intraocular and total high-order aberrations of the cornea were observed and compared between before and after the surgery. Main Outcome Measures The root mean square (RMS) values of total HOAs, spherical aberration, coma, trefoil, and secondary astigmatism for the corneal. Results The intraocular HOAs preoperatively and postoperatively were 0.291±0.214 μm and 0.169 ± 0.145 μm, respectively (t=4.223, P<0.001), and the total HOAs were 0.299±0.213 μm and 0.188±0.149 μm, respectively(t=3.963, P<0.001). The postoperative intraocular spherical aberration increased towards to the negative direction compared to preoperatively (t=3.191, P=0.002), and the corneal trefoil aberration also increased (t=-2.305, P=0.024). There were no significant changes in the total corneal HOAs, coma, and secondary astigmatism compared to preoperatively (all P>0.05). Conclusion ICL V4c implantation corrects refractive errors and also reduces the total HOAs and the intraocular HOAs, with the exception of spherical aberration. The negative spherical aberration of the ICL led to an increase in intraocular spherical aberration, and the corneal trefoil aberration increased due to the creation of corneal incisions, while other corneal HOAs remained unchanged. (Ophthalmol CHN, 2025, 34: 53-57)

Key words: higher-order aberrations, implantable collamer lens, myopia