Femtosecond laser versus mechanical microkeratome in LASIK for myopia: A meta-analysis comparison of visual effect postoperative

Abstract

Objective To evaluate the clinical effectiveness of femtosecond laser-assisted compared to microkeratome-assisted in LASIK for myopic.Methods Electronic searched of PubMed,EM-base,CNKI,VIP,SinoMed,Wanfang data,Baidu library,Google scholar and ASCRS data.Search time from January 1,2004 to May 14,2013 in Chinese and English.Search for study about femtosecond Laser versus mechanical microkeratome in LASIK for myopia.The randomized controlled trials (RCTs) were included in accordance with the Cochrane reviews methodology.The quality of included literature was scored according to the Jadad Scale.The statistical analysis was performed using a RevMan 5.2 software.The methodological quality was evaluated by two reviewers independently with weighted mean difference (WMD) for the effectiveness analysis and odds ratio (OR) for counting variable.Results Total of 19 studies were include in the meta-analysis.The results showed that the total patients of manifest refraction spherical equivalent within ±0.50 diopters(D) at 1 month and 3 months postoperatively was not significantly different between these two groups,although the femtosecond group set slightly higher than the microkeratome group [MD=1.29,95％CI (0.61,2.73),P =0.50],[MD=1.28,95％CI (0.72,2.28),P =0.41]; the postoperative uncorrected visual acuity (UCVA) at 3,6 months showed that femtosecond group higher than microkeratome group with significantly differences between groups [MD=0.04,95％CI (0.03,0.06),P ＜ 0.00001],[MD=0.03,95％CI (0.00,0.05),P =0.03]; the percentage of eyes that postoperative UCVA at 3 months as good as or better than the preoperative best spectacle-corrected visual acuity (BSCVA) showed that femtosecond group more than microkeratome group with significantly differences between groups [MD=1.70,95％CI (1.34,2.15),P ＜0.0001]; there were significantly differences in total high-order aberration (HOA) and coma aberration (CA) at 3,6 months postoperatively between groups,femtosecond group was immediately below microkeratome group,describe the sequence showed total HOA[MD=-0.11,95％CI (-0.17,-0.04),P =0.0008],[MD=-0.08,95％CI (-0.13,-0.03),P =0.002],CA[MD=-0.04,95％CI (-0.08,-0.01),P =0.01],[MD=-0.08,95％CI (-0.14,-0.01),P =0.02]; and the spherical aberration at 3 months postoperatively also showed that femtosecond group was immediately below microkeratome group with significantly differences between groups [MD=-0.05,95％CI (-0.09,-0.00),P =0.04].Conclusions The LASIK that corneal flap made by femtosecond laser may get better visual effect than that by mechanical microkeratome. Key words: Femtosecond laser; Microkeratome; Laser in situ keratomileusis