Clinical Trials in Refractive Surgery
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Excimer Laser Refractive Surgery Vs Phakic IOL For Moderate- High Myopia: Cochrane Review
Objective
To compare the outcomes of excimer laser refractive surgery and phakic IOL for correcting moderate to high myopia by evaluating postoperative uncorrected visual acuity (UCVA), refractive outcome, loss of best spectacle-corrected visual acuity (BSCVA) and the adverse effects.
Inclusion Criteria
A randomized controlled trial (RCT) for correcting myopia greater than 6 diopters (D) spherical equivalent.
Results and Summary
A total of 228 eyes in 3 RCTs were included. Patients with - 6 to - 20 diopters myopia with up to - 4D myopic astigmatism were included in the review. It was noted that the percentage of eyes with UCVA 20/20 or better was not significantly different between the two groups at 1-year follow-up. At 12 months postoperatively, less loss of BSCVA was seen in patients with phakic IOL making it safer than the excimer laser correction for moderate to high myopia. Phakic IOLs resulted in better contrast sensitivity and low risk for early cataract formation with a high patient satisfaction score compared to laser vision correction for moderate to high myopia.[1]
Clinical Outcomes of Laser-Assisted Subepithelial Keratectomy (LASEK) vs. Photorefractive Keratectomy (PRK) - Meta-analysis
Objective
To analyze the differences in the clinical outcomes between LASEK and PRK in patients with myopia.[2]
Study Design
Meta-analysis and systematic review
Methods
A thorough review of the literature was conducted and previous RCTs and comparative studies comparing the clinical outcomes of LASEK and PRK in patients with myopia were included.
Outcome Measures
UCVA 20/20 or better, Mean refractive spherical equivalent (MRSE) of ±0.5D, final SE and final UCVA 20/40 or worse were considered the primary outcomes. The secondary outcome measures were postoperative pain, corneal haze and corneal epithelium regeneration time.
Results
A total of 499 eyes that underwent PRK were compared with 512 eyes with LASEK treatment for myopia using twelve previous studies. Odds ratio (OR), Weighted mean difference (WMD) and standardized mean difference (SMD) were analyzed. No significant difference in the two groups in the final SE (WMD 0, P=0.95), MRSE within ±0.5 (OR 0.86, P=0.37), final UCVA 20/40 or worse (OR 1.26, P=0.52), epithelium healing time (P= 0.77) and postoperative pain (P=0.27) was noted. However, a statistically significant difference in the corneal haze between LASEK-treated eyes at 1 month post-op (P=0.0007) and 3 months (P=0.03) and PRK where LASEK-treated eyes showed less corneal haze but this difference was not significant at 6 months follow up (P=0.08).
Conclusion
No significant difference was noted in the clinical outcomes in eyes treated with LASEK vs PRK. Eyes with LASEK treatment showed less corneal haze 1-3 months post-surgery.
- ↑ 1. Barsam A, Allan BDS. Excimer laser refractive surgery versus phakic intraocular lenses for the correction of moderate to high myopia. Cochrane Database Syst Rev. 2014;2014(6):CD007679. doi:10.1002/14651858.CD007679.pub4
- ↑ 2. Zhao LQ, Wei RL, Cheng JW, Li Y, Cai JP, Ma XY. Meta-analysis: clinical outcomes of laser-assisted subepithelial keratectomy and photorefractive keratectomy in myopia. Ophthalmology. 2010;117(10):1912-1922. doi:10.1016/j.ophtha.2010.02.004
