Postoperative Efficacy, Predictability, Safety, and Visual Quality of Laser Corneal Refractive Surgery: A Network Meta-analysis

Wen, Daizong; McAlinden, Colm; Flitcroft, Ian; Tu, Ruixue; Wang, Qinmei; Alió, Jorge L.; Marshall, John; Huang, Yingying; Song, Benhao; Hu, Liang; Zhao, Yune; Zhu, Shiping; Gao, Rongrong; Bao, Fangjun; Yu, A-Yong; Yu, Yang; Lian, Hengli; Huang, Jinhai

doi:10.1016/j.ajo.2017.03.013

Cited by 120 publications

(100 citation statements)

References 56 publications

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“…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. FS-LASIK behaved better in predictability than any other type of surgery.…”

Section: Laser Ablation Algorithmsmentioning

confidence: 98%

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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Section: Laser Ablation Algorithmsmentioning

confidence: 98%

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

Hjortdal¹

2017

European Ophthalmic Review

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“…The paradigm of Lasek surgery is to restore the epithelium immediately after stromal photoablation with the aid of dilute alcohol [15]. There is a debate about the interest of replacing the epithelial flap in terms of decreased speed recovery and pain [16,17]. Theoretically, on the one hand, it has flap creation advantages with less discomfort and possibly increased recovery speed; on the other hand, the safety of PRK.…”

Section: Lasek and Its Advantagesmentioning

confidence: 99%

Advantages of Surface Ablation in Excimer Laser Surgery

Chraïbi

2020

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In this article, we review the advantages of corneal laser surface surgery to explain the current trend toward this technique. The excimer laser in corneal surface surgery can be used for two reasons. On the one hand, to correct a refractive error by photorefractive keratectomy (PRK) and its two variants; Laser epithelial keratomileusis (LASEK) and Epithelial Laser-assisted in situ keratomileusis (Epi-lasik). On the other hand, it is used to perform superficial corneal capacities photoablation, among other uses, by Phototherapeutic keratectomy (PTK). PRK is regaining popularity thanks to its better safety profile, mitomycin C usage and improvement of photoablation profiles. Lasek and Epilasik are less frequently performed nowadays. PTK is an important element in the techniques used to improve visual acuity in a wide range of corneal conditions such as corneal scars, recurrent erosion syndrome and corneal dystrophies.

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“…Ang RE et al [10] and Zhang Y et al [11] were reported that flap-off epi-LASIK with MMC has less pain, corneal haze and faster visual recovery, while visual results, refractive outcomes, contrast sensitivity (CS), and higher-order aberrations (HOAs) were comparable with flap-on epi-LASIK. Wen D and associates [12] published a network meta-analysis to comparative evaluation the visual outcomes and visual quality, the report shows that there were no statistically significant difference in either visual outcomes (efficacy and safety) or visual quality (HOAs and CS), but femto-LASIK behaved better in predictability than any other type of surgeries. Additionally, the thinner corneas, higher intraocular pressure (IOP), and higher myopia requiring greater laser ablation are more predisposed to the anterior shift of the cornea.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Visual Outcomes for Myopia after Refractive Surgery using Femtosecond Laser-assisted and Epipolis LASIK

Piao¹,

Yoo²,

Whang

et al. 2019

Preprint

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Purpose This study was to clinically evaluate the visual outcomes after refractive surgery for myopia using femtosecond laser-assisted in situ keratomileusis (femto-LASIK) and epipolis LASIK (flap-off epi-LASIK). Methods Forty eyes of 27 patients were divided into 2 groups in a retrospective study. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), manifest refraction (MR),corneal asphericity (Q-value) and corneal higher-order aberrations (HOAs) were assessed pre- and postoperatively. Results The pre- and postoperative changes in flattest keratometry reading(K1), steepest keratometry reading(K2), central corneal thickness(CCT), and only Q-value of the anterior surface was statistically significant for both groups (femto-LASIK: P=0.014, P=0.03, P<0.001, P=0.001, respectively; epi-LASIK: all P<0.001). The postoperative corneal thickness spatial profile (CTSP) were statistically significant thinner than preoperative CTSP in both procedures (all P<0.05), and the epi-LASIK was significant thinner than femto-LASIK at 6 mm ring of CTSP (P=0.039). The improvement in LogMAR UDVA after refractive surgery was statistically significant for both groups (P<0.001 for all groups); it was significantly improved for femto-LASIK on day 1 and at 1 week postoperatively (P<0.001, P=0.019, respectively). In analysis of corneal HOAs, there were significant reduction of vertical coma aberration and horizontal secondary astigmatism aberration, and induction of spherical aberration in the front corneal HOAs after femto-LASIK (P=0.021, P=0.001, P=0.001, respectively); in the total corneal HOAs changes were the same pattern as the front corneal HOAs (P=0.007, P=0.004, P<0.001, respectively), but in the back corneal HOAs changes, a few significant induction of vertical coma aberration, and reduction of oblique trefoil aberration and oblique tetrafoil aberration (all P<0.05). In flap-off epi-LASIK, there were only significant induction of SA in the front and total corneal HOAs after surgery (all P<0.05); in the back corneal HOAs, a few significant induced horizontal secondary astigmatism aberration and reduced SA aberration (P=0.027, P=0.011, respectively), however, the back corneal HOAs changes were not significant effect on the total corneal HOAs changes. Conclusion Femto-LASIK showed better early visual outcomes than that noted by epi-LASIK, but there was no significant difference between the outcomes of the 2 procedures 1 week postoperatively.

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Postoperative Efficacy, Predictability, Safety, and Visual Quality of Laser Corneal Refractive Surgery: A Network Meta-analysis

Abstract: This network meta-analysis shows that there were no statistically significant differences in either visual outcomes (efficacy and safety) or visual quality (HOAs and CS). FS-LASIK behaved better in predictability than any other type of surgeries.

Cited by 120 publications

References 56 publications

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

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

Advantages of Surface Ablation in Excimer Laser Surgery

Comparison of Visual Outcomes for Myopia after Refractive Surgery using Femtosecond Laser-assisted and Epipolis LASIK

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