Laser-Assisted Subepithelial Keratectomy versus Laser In Situ Keratomileusis in Myopia: A Systematic Review and Meta-Analysis.

Li-Quan Zhao,Huang Zhu,Liang-Mao Li

doi:10.1155/2014/672146

Abstract

This systematic review was to compare the clinical outcomes between laser-assisted subepithelial keratectomy (LASEK) and laser in situ keratomileusis (LASIK) for myopia. Primary parameters included mean manifest refraction spherical equivalent (MRSE), MRSE within ±0.50 diopters, uncorrected visual acuity (UCVA) ≥20/20, and loss of ≥1 line of best-corrected visual acuity (BCVA). Secondary parameters included flap complications and corneal haze. Twelve clinical controlled trials were identified and used for comparing LASEK (780 eyes) to LASIK (915 eyes). There were no significant differences in visual and refractive outcomes between the two surgeries for low to moderate myopia. The incidence of loss of ≥1 line of BCVA was significantly higher in moderate to high myopia treated by LASEK than LASIK in the mid-term and long-term followup. The efficacy (MRSE and UCVA) of LASEK appeared to be a significant worsening trend in the long-term followup. Corneal haze was more severe in moderate to high myopia treated by LASEK than LASIK in the mid-term and long-term followup. The flap-related complications still occurred in LASIK, but the incidence was not significantly higher than that in LASEK. LASEK and LASIK were safe and effective for low to moderate myopia. The advantage of LASEK was the absence of flap-related complications, and such procedure complication may occur in LASIK and affect the visual results. The increased incidence of stromal haze and regression in LASEK significantly affected the visual and refractive results for high myopia.

Highlights

Since laser-assisted subepithelial keratectomy (LASEK) was introduced to refractive surgery in recent decade, many clinical controlled trials have been reported [1,2,3,4,5,6,7,8,9,10,11,12]
We performed a meta-analysis of existing randomized control trials (RCTs) and comparative studies of LASEK versus laser in situ keratomileusis (LASIK) for the treatment of myopia in an attempt to detect any differences in safety and efficacy as the primary concern between the two techniques
To achieve the maximum sensitivity of the search strategy and identify all trials comparing LASEK and LASIK, we used appropriate free text and thesaurus terms including “Laser-Assisted Subepithelial Keratectomy” or “Laser Subepithelial Keratomileusis” or “Laser-Assisted Subepithelial Keratomileusis” or “Subepithelial Photorefractive Keratectomy” or “LASEK” and “Laser In Situ Keratomileusis” or “LASIK.” After the relevant titles were identified, the abstracts and full text of these studies were reviewed to decide whether they met criteria for our study

Summary

Introduction

Since laser-assisted subepithelial keratectomy (LASEK) was introduced to refractive surgery in recent decade, many clinical controlled trials have been reported [1,2,3,4,5,6,7,8,9,10,11,12]. We performed a meta-analysis of existing RCTs and comparative studies of LASEK versus LASIK for the treatment of myopia in an attempt to detect any differences in safety and efficacy as the primary concern between the two techniques. Corneal haze and flap-related complications influence final visual outcomes. These 2 key variables were chosen as secondary outcome parameters in this study

Methods

Results

Conclusion