Comparison of correction formulas for intraocular pressure measured by Goldmann tonometer following various refractive surgeries (FS-LASIK, SMILE, tPRK).

OBJECTIVE

This study aims to compare different intraocular pressure (IOP) correction formulas in post-refractive surgery patients who underwent Femtosecond Laser-Assisted In Situ Keratomileusis (FS-LASIK), Small Incision Lenticule Extraction (SMILE), and Trans-epithelial Photorefractive Keratectomy (tPRK), and to identify the most accurate formula for correcting IOP values measured by Goldmann applanation tonometer (GAT).

METHODS

This prospective study included 160 patients (160 eyes) who underwent FS-LASIK (58 eyes), SMILE (52 eyes), or tPRK (50 eyes) at the Eye Hospital, Wenzhou Medical University. IOP was measured using GAT and Dynamic Contour Tonometry (DCT) preoperatively and 3 months postoperatively. Optical zone diameter, ablation depth (AD), residual stromal thickness, refractive error correction, central corneal thickness (CCT), and mean corneal curvature (Km) were collected. Fourteen published GAT correction formulas (F1-F14) were applied to postoperative GAT values and compared with preoperative measurements. Differences between pre- and postoperative DCT readings served as a reference.

RESULTS

In FS-LASIK and SMILE, formulas F3, F4, and F11 showed superior correction performance. In FS-LASIK, the mean differences, concordance correlation coefficients (CCC), and proportions of differences within ±2 mmHg were closer to or better than the DCT reference (0.58, 0.572, 55.17%), with F3 (0.25, 0.372, 72.41%), F4 (0.20, 0.373, 63.79%), and F11 (0.04, 0.324, 67.24%) showing high agreement. Similarly, in SMILE, F3 (0.25, 0.379, 57.69%), F4 (0.22, 0.375, 61.54%), and F11 (0.01, 0.399, 63.46%) outperformed or approximated DCT (0.86, 0.447, 44.23%). In tPRK, F1 (0.18, 0.653, 64.00%) and F2 (0.25, 0.316, 62.00%) provided better correction than DCT (0.19, 0.493, 56.00%).

CONCLUSION

Formulas F3, F4, and F11 are applicable for GAT IOP correction in both FS-LASIK and SMILE eyes. F1 and F2 are more suitable for tPRK; the preoperative IOP parameters included in F1 may lead to assessment bias, making F2 the recommended choice when preoperative IOP is unavailable.