Epipolis-laser in situ keratomileusis versus photorefractive keratectomy for the correction of myopia: a meta-analysis
PURPOSE To determine the differences in the visual results, pain response, biomechanical effect, quality of vision, and higher-order aberrations, among other parameters, in eyes undergoing either photorefractive keratectomy (PRK) or thin-flap LASIK/sub-Bowman keratomileusis (SBK; intended flap thickness of +/-100 microm and 8.5-mm diameter) at 1, 3, and 6 months after surgery. DESIGN A contralateral eye pilot study. PARTICIPANTS Fifty patients (100 eyes) were enrolled at 2 sites. METHODS The mean preoperative spherical refraction was -3.66 diopters (D) and the mean cylinder was -0.66 D for all eyes. Eyes in the PRK group underwent 8.5-mm ethanol-assisted PRK, whereas in eyes in the SBK group, an 8.5-mm, (intended) 100-microm flap was created with a 60-kHz IntraLase femtosecond laser (Advanced Medical Optics, Santa Ana, CA). All eyes underwent a customized laser ablation using an Alcon LADARVision 4000 CustomCornea excimer laser (Alcon Laboratories, Fort Worth, TX). MAIN OUTCOME MEASURES Preoperative and postoperative tests included best spectacle-corrected visual acuity, uncorrected visual acuity (UCVA), corneal topography, wavefront aberrometry, retinal image quality, and contrast sensitivity. Patients completed subjective questionnaires at each visit. RESULTS One- and 3-month UCVA results showed a statistically significant difference: SBK, 88% 20/20 or better vs. 48% 20/20 or better for PRK. At 6 months, UCVA was 94% 20/20 or better for PRK and 92% for SBK. At 1 and 3 months, the SBK group had lower higher-order aberrations (coma and spherical aberration; P<or=0.05); at 1, 3, and 6 months, there was no statistically significant difference in spherical aberration and vertical and horizontal coma between the 2 groups. CONCLUSIONS At the 1-month follow-up, the thin-flap/SBK group demonstrated clinically and statistically significant better visual acuity than the PRK group. By 3 months, the vision in the 2 groups had begun to equalize, although the SBK eyes continued to have better vision. At 6 months, there were no statistical differences between the 2 groups. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found after the references.