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Introduction: Refractive surgery procedures, transepithelial photorefractive keratectomy (T-PRK), and femtosecond laser in situ keratomileusis (Fs-LASIK) are regarded as safe and efficacious methods for correcting myopia and myopic astigmatism. These two methods do not have many differences in results when treating spherical myopia while differences exist in the treatment of astigmatism correction. Vector analysis presents a powerful tool to show the real differences between these two methods regarding high ocular aberrations and central corneal thickness of treated eyes. Aim: The aim of the study is to investigate changes in higher order ocular aberrations (HOAs) and central corneal thickness (CCT) following treatment of myopia and myopic astigmatism above -5.00DS and up to -2.00DC after either T-PRK or Fs-LASIK. Methods: Patients (30 eyes per group) underwent T-PRK (group I) or Fs-LASIK (group II) procedure using the Schwind Amaris 750S laser. HOAs (3mm&5mm pupil) and CCT were measured objectively at pre-, 1,3 & 6 months postop in each case. Results: Key results at 6 months were: i) mean values of trefoil (5mm pupil) were 0.092μm (sd,0.055,95% CI 0.072 to 0.112) & 0.126μm (sd,0.078,95% CI 0.098 to 0.154) in group I, and 0.088μm (sd,0.058,95% CI 0.067 to 0.109) & 0.064μm (sd,0.034,95% CI 0.052 to 0.076) in group II (P=0.001 at 6 months); ii) Changes in CTT (ΔCTT) and best spherical equivalent correction (ΔBSE) was significant in group II (ΔCCT=-26.55[ΔBSE]-14.06,R=0.486,P=0.006) but not in group I (p=0.034). Conclusions: After T-PRK trefoil is worse than Fs-LASIK. The predictability of corneal changes is better following Fs-LASIK.

There is no clear reason to explain why the patient developed bilateral corneal steepening. It could be that the patient's corneal stromal fibers gradually weakened over this 5-year period.

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