One-Year Prospective Contralateral Eye Study: Visual Outcomes of Topography-guided LASIK Versus KLEx for Myopia and Myopic Astigmatism.

PURPOSE: To compare 12-month visual outcomes, higher order aberrations (HOAs), epithelial remodeling patterns, and patient-reported outcomes (PROs) between topography-guided laser in situ keratomileusis (TG-LASIK) and keratorefractive lenticule extraction (KLEx).

METHODS

Forty patients (80 eyes) underwent TG-LASIK in one eye and KLEx in the fellow eye for myopia with and without astigmatism. Preoperative and up to 12-month evaluations included uncorrected distance visual acuity (UDVA), corrected distance visual acuity, contrast sensitivity, HOAs, corneal epithelial analysis, corneal hysteresis (CH), corneal resistance factor (CRF), and PROs.

RESULTS

At 1 year, all eyes achieved a UDVA of 20/20 or better. Spherical equivalent (SEQ) stability did not differ between groups. TG-LASIK showed better contrast sensitivity than KLEx at 1 month (P < .001), which became comparable by 3 months. KLEx had more undercorrected cylinder than TG-LASIK at 12 months (P = .033), with 97.5% of TG-LASIK and 85% of KLEx eyes achieving a residual cylinder of 0.50 diopters or less (P = .02). KLEx induced higher vertical coma (P < .001), whereas spherical aberration remained statistically unchanged in both groups. By 1 month, KLEx removed 2.5 ± 3.4 μm/diopter more stromal tissue (P < .001); however, epithelial remodeling within the 2- and 5-mm zones compensated for this loss by 1 year. The decline in CH and CRF postoperatively was similar between platforms (P > .05). At 12 months, there was no difference in subjective and objective dry eye symptoms between groups.

CONCLUSIONS

KLEx resulted in greater vertical coma, stromal consumption per diopter, and undercorrected cylinder. Although early differences in PROs, eye preference, and contrast sensitivity transiently favored TG-LASIK, both procedures were comparable in terms of stability, predictability, CH, CRF, and patient satisfaction at 12 months.