Comparison of the visual and optical outcomes after different corneal refractive surgeries for asymmetric corneal astigmatism.

PURPOSE: To compare visual and optical outcomes after selective corneal wavefront aberration-guided femtosecond laser-assisted in situ keratomileusis (CW-FS-LASIK), aspheric aberration-free femtosecond laser-assisted in situ keratomileusis (AF-FS-LASIK), and small-incision lenticule extraction (SMILE) in patients with asymmetric corneal astigmatism.

METHODS

This retrospective comparative study included 269 patients (269 eyes) who underwent CW-FS-LASIK (67 eyes), AF-FS-LASIK (69 eyes), or SMILE (133 eyes) for myopia with asymmetric corneal astigmatism. Asymmetric corneal astigmatism was defined as an inferior-superior (I-S) dioptric difference of at least 1.00 D within the central 3 mm anterior corneal zone on the anterior sagittal curvature map. Visual and refractive outcomes, functional optical zone (FOZ), decentration, and corneal higher-order aberrations (HOAs) at analysis diameters of 4 and 6 mm were compared at 1 month postoperatively.

RESULTS

Baseline characteristics were comparable among the three groups except for sex distribution. At 1 month, visual and refractive outcomes were comparable, and no significant difference in decentration was observed. FOZ was larger in the SMILE group than in the other groups (P < 0.001). At the 4 mm analysis diameter, postoperative total HOAs and total coma were lower in the CW-FS-LASIK group. At the 6 mm analysis diameter, induced total coma was lowest in the CW-FS-LASIK group, whereas induced spherical aberration was lowest in the SMILE group.

CONCLUSIONS

All three procedures achieved similarly favorable early visual and refractive outcomes in eyes with asymmetric corneal astigmatism. CW-FS-LASIK showed lower corneal coma, but its clinical relevance remains uncertain and requires further validation with patient-reported outcomes.