Comparison of different refractive surgeries for correcting high myopia

Abstract

Objective To evaluate the quality of vision after implantation of a Verisyse phakic intraocular lens (PIOL) and laser in situ keratomileusis (LASIK) for correcting high myopia,and to evaluate a rational surgical approach for high myopia.Methods This was a prospective non-randomized control trial.Thirty eyes (30 patients) underwent LASIK and 30 eyes (30 patients) were implanted with Verisyse IOLs.Preoperative spherical equivalents were-15.41 ±4.68 D and-16.94±5.42 D,respectively.Wavefront aberrations were measured using a subjective aberrometer (WFA1000B)preoperatively and 6 months postoperatively.Higher-order aberrations (HOAs) were recorded and compared.Patient satisfaction (photic phenomena,overall satisfaction) was assessed by a subjective questionnaire.The data from the two groups was statistically analyzed by a t or x2 test.Results Six months after surgery,uncorrected visual acuity (UCVA) and best corrected visual acuity (BCVA) had improved.Postoperative UCVA was equal to or better than preoperative BCVA in 70％(21/30) in the Verisyse group and 43.3％(13/30) in the LASIK group.The difference between the groups was statistically significant (x2=4.34,P＜0.05).3rd to 7th order and total HOAs increased in both groups after surgery,especially in the LASIK group.In the Verisyse group,3rd order aberrations were the predominant postoperative HOA and horizontal coma increased significantly (t=2.12,P＜0.05); in the LASIK group,3rd and 4th order aberrations were the predominant postoperative HOA,and coma and spherical aberrations increased significantly (t=-6.55,-7.37,P＜0.05).Each order and total HOAs in the LASIK group were higher than that in the Verisyse group,and the difference was statistically significant.Patient satisfaction was 60％ in the LASIK group and 83.3％ in the Verisyse group (x2=4.02,P＜0.05).Conclusion PIOL and LASIK surgery were found to be comparatively safe and effective for high myopia.But when quality of vision is taken into account,UCVA was better with PIOL implantation and it resulted in a smaller increase in HOAs and higher patient satisfaction compared to LASIK.Therefore,PIOL implants may be considered as the first choice for high myopia. Key words: Myopia,degenerative; Higher-order aberration; Keratomileusis,laser in situ; Phakic intraocular lenses; Iris-fixated