Comparison of Clinical Outcomes of Contralateral Topography-guided Laser In Situ Keratomileusis Versus Keratorefractive Lenticule Extraction: A Prospective Study.

PURPOSE: To compare the visual outcomes and patient-reported symptoms of volunteers with myopia and myopic astigmatism who had topography-guided laser in situ keratomileusis (TG-LASIK) in one eye and keratorefractive lenticule extraction (KLEx) in the other eye.

METHODS

This was a prospective, randomized, contralateral study. Participants aged 21 to 50 years underwent TG-LASIK and KLEx contralaterally. Participants included had myopia between -2.00 and -8.00 diopters (D) with astigmatism of 3.00 D or greater. Postoperative month 6 (POM6) visual and refractive outcomes and patient-reported symptoms were reported for 49 participants (98 eyes).

RESULTS

TG-LASIK [L] resulted in more eyes achieving uncorrected distance visual acuity (UDVA) of 20/16 or better than KLEx [K] eyes at POM6 (L = 43%, K = 29%; P = .038). TG-LASIK outperformed KLEx in mean UDVA (L = -0.08 ± 0.05 logMAR [Snellen 20/17], K = -0.05 ± 0.09 logMAR [Snellen 20/18]; P = .013; Cohen's d = 0.41), corrected distance visual acuity (CDVA) (L = -0.12 ± 0.05 logMAR [Snellen 20/15], K = -0.10 ± 0.04 logMAR [Snellen 20/16]; P = .001), residual manifest cylinder (L = 0.16 ± 0.17 D, K = 0.31 ± 0.34 D; P = .012; Cohen's d = 0.56), low contrast (LC) UDVA (L = 0.24 ± 0.10 logMAR [Snellen 20/32], K = 0.28 ± 0.12 logMAR [Snellen 20/38]; P = .006), and LC CDVA (L = 0.21 ± 0.08 logMAR [Snellen 20/32], K = 0.22 ± 0.08 logMAR [Snellen 20/33]; P = .026). TG-LASIK induced fewer total higher order aberrations (HOAs) (L = 0.49 ± 0.22 µm, K = 0.57 ± 0.21 µm; P < .0006), vertical coma (L = -0.10 ± 0.31 µm, K = -0.17 ± 0.33 µm; P = .011; Cohen's d = 0.09), and vertical trefoil (L = 0.03 ± 0.11 µm, K = -0.03 ± 0.17 µm; P = .020; Cohen's d = 0.43) and resulted in better patient vision satisfaction score than KLEx (L = 1.25 ± 0.48, K = 1.41 ± 0.64; P = .044).

CONCLUSIONS

At POM6, TG-LASIK provided superior UDVA, CDVA, LC UDVA, LC CDVA, and lower HOAs and residual manifest cylinder compared to KLEx. Patients reported greater vision satisfaction with TG-LASIK.