Meta-analysis: Clinical Outcomes of Laser-Assisted Subepithelial Keratectomy and Photorefractive Keratectomy in Myopia

Zhao, Li-Quan; Wei, Rui-Li; Cheng, Jin-Wei; Li, You; Cai, Jun; Ma, Xin

doi:10.1016/j.ophtha.2010.02.004

Cited by 47 publications

(42 citation statements)

References 41 publications

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“…Zhao et al [15] reported a comprehensive literature search using Cochrane Collaboration methodology to identify randomized controlled trials of PRK (499 eyes) versus LASEK (512 eyes); however, this study had the drawbacks of being a systematic review and meta-analysis. Bentio-Llopis et al [16] evaluated 1036 eyes treated with LASEK in a single institution and their data showed LASEK is definitely effective, safe and predictably corrects myopia.…”

Section: Discussionmentioning

confidence: 99%

“…In our study, corneal haze should also be a main reason for loss of BSCVA, because corneal haze contributed to 24 of 47 (51.1%) and 19 of 29 (65.5%) eyes of those that lost two or more lines of BSCVA at 3 months and 6 months postoperatively, respectively. Thus, some risk is inescapable with a LASEK procedure [8] [15] and, therefore, use of MMC might lead to widespread reduction in the incidence of this complication. Nevertheless, when applied to the cornea, MMC could potentially damage corneal epithelial [18] [19], stromal cells [20] [21], and endothelial cells [22] [23], so the possible toxicity of this drug remains a subject of intense debate [11].…”

Section: Discussionmentioning

confidence: 99%

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Re-Evaluation of the Safety of Laser-Assisted Subepithelial Keratectomy

Kumano¹,

Soejima²,

Numa³

et al. 2014

OJOph

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Purpose: Additional analyses of outcomes of laser-assisted subepithelial keratectomy (LASEK) are still necessary to improve the safety of LASEK. Therefore, in our study, outcomes were assessed retrospectively in 561 eyes that underwent LASEK treatment. Methods: Uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA) and residual spherical equivalent were analyzed at 3 and 6 months postoperatively. We assessed four subgroups based on the degree of preoperative myopia considering mean BSCVA and loss of two or more lines. Results: Mean UCVAs and BSCVAs were obtained at 3 and 6 months postoperatively (1.23/1.35 and 1.23/1.37, respectively). The mean predictability was within ±0.125 diopters. Conversely, the safety indexes were 0.94 and 0.96 respectively, and the efficacy indexes were 0.86 and 0.86 at 3 and 6 months postoperatively, respectively. 8.4% eyes and 5.2% eyes lost two or more lines of BSCVA at 3 and 6 months postoperatively, respectively. The mean BSCVAs of the high or ultra-high groups were significantly lower than those of the low or mild groups both 3 months and 6 months postoperatively. The incidence rates of losing two or more lines of BSCVA in the high or ultra-high myopia groups were significantly greater than in the low or mild groups at 3 months and 6 months postoperatively. Conclusion: LASEK predictably corrected myopia achieving >1.2 in UCVA and BSCVA. However, the safety and efficacy indexes were <1.0, which were related to the loss of two or more lines of BSCVA. Since the incidence rates of losing two or more lines of BSCVA were greater in the high or ultra-high myopia groups, we consider LASEK as more safely performed in patients with low to mild preoperative myopia.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Re-Evaluation of the Safety of Laser-Assisted Subepithelial Keratectomy

Kumano¹,

Soejima²,

Numa³

et al. 2014

OJOph

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“…A similar conclusion was reached and published in 2010. 50 Most recently, a network-based meta-analysis comparing the postoperative efficacy, predictability, safety and visual quality of all major forms of laser corneal refractive surgeries (PRK, LASEK, Epi-LASIK, trasepithelial PRK, LASIK, femtosecond assisted [FS-LASIK], small incision lenticule extraction and femtosecond lenticule extraction) for correcting myopia was published. 51 Based on analysis of 48 RCTs, the authors concluded that this network meta-analysis showed that there were no statistically significant differences in both visual outcomes (efficacy and safety) and visual quality (higher-order aberrations and contrast sensitivity) between the techniques.…”

Section: Laser Ablation Algorithmsmentioning

confidence: 99%

Surface Ablation Techniques for Myopia – A Review of the Advances Over the Past 25 Years

Hjortdal¹

2017

European Ophthalmic Review

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Photorefractive keratectomy for correction of myopia was the first excimer laser-based technique to be developed. During the last 25 years, excimer lasers have improved technologically, several variations of the technique have been developed and pre-and postoperative pharmaceutical therapies have been investigated. This review article summarises these developments and the published meta-analyses on comparison of surface ablation techniques and laser in situ keratomileusis. The main conclusion is that there seem to be no differences between the clinical results obtained with the different variations of surface ablation techniques. KeywordsPhotorefractive keratectomy, laser in situ keratomileusis (LASIK), refractive surgical procedures, myopia, excimer laser Disclosure: Jesper Hjortdal discloses that Aarhus University Hospital has signed a research support agreement with Carl Zeiss Meditec, Jena Germany. No funding was received in the publication of this article. This study involves a review of the literature and did not involve any studies with human or animal subjects performed by any of the authors.Authorship: All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship of this manuscript, take responsibility for the integrity of the work as a whole, and have given final approval to the version to be published.Open Access: This article is published under the Creative Commons Attribution Noncommercial License, which permits any non-commercial use, distribution, adaptation and reproduction provided the original author(s) and source are given appropriate credit. When such a gas is put under electrical stimulation and high pressure, the excited compound can give up its excess energy by undergoing spontaneous emission, which very quickly (on the order of a picosecond) dissociates back into two unbound atoms. Directing the emitted light towards, for example, biological materials will result in ablation of surface molecules. In the early 1980s it was shown that using this approach biological materials, including the cornea, could be incised using the excimer laser.1-3 After short time, it was realised that actual surface ablation of the corneal stroma was possible after removal of the corneal epithelium 4 and that the resulting surface was very smooth. 5 In 1987, excimer laser-based keratotomy was performed in a human eye, 6 but it was the surface ablation application that pushed development of excimer lasers. 7,8 The first preliminary results in human eyes were published the late 1980s 9-12 and excimer lasers became commercially available around 1990. In the early 1990s larger follow-up series of patients undergoing PRK for myopia were published. [13][14][15] Since then, many modifications of PRK have been introduced, and a common uniting name for all these techniques is 'surface ablation'. This review will focus on surface ablation for myopia. Development of excimer lasersDirecting the location of the excimer laser rays is essential to change the surface shape of the ...

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“…Intrastromal techniques are the most widely used, but surface ablation techniques still have a relevant role [1][2][3]. Surface ablation techniques are often preferred in eyes with thin corneas, superficial corneal scars, anterior basement membrane dystrophies, dry-eye syndrome and as re-treatment following small-incision lenticule extraction or in patients predisposed for contact injury [4][5][6][7].…”

Section: Introductionmentioning

confidence: 99%

“…Disadvantages of surface ablation techniques include a relatively long visual recovery period, postoperative pain, and higher risk of corneal haze and myopic regression as compared to intrastromal techniques, especially when treating high degrees of myopia [2,5,6,8,9]. Technological advancements with larger optical zones, corneal cooling, epithelial repositioning, mitomycin C, and highfrequency flying-spot excimer lasers with eye-trackers have improved outcomes and reduced the risk of complications after surface ablation techniques [3,7,[10][11][12][13][14][15][16]. The umbrella term for many of these improvements is "advanced surface ablation," which includes photorefractive keratectomy with cooling (cPRK) and laser-assisted subepithelial keratectomy (LASEK), among others [17].…”

Section: Introductionmentioning

confidence: 99%