Comparison of 10-year Clinical Results between Laser in situ Keratomileusis and Surface Ablation for Moderate to High Myopia

Hyo Won Kim; Kyung Sun Na; Man Soo Kim

doi:10.3341/jkos.2016.57.3.380

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Kim, Na, and Kim: Comparison of 10-year Clinical Results between Laser in situ Keratomileusis and Surface Ablation for Moderate to High Myopia

Original Article

J Korean Ophthalmol Soc 2016;57(3):380-389.

Published online: 3 September 2016

DOI: https://doi.org/10.3341/jkos.2016.57.3.380

Comparison of 10-year Clinical Results between Laser in situ Keratomileusis and Surface Ablation for Moderate to High Myopia

Hyo Won Kim, MD, Kyung Sun Na, MD, PhD, Man Soo Kim, MD, PhD

Department of Ophthalmology and Visual Science, College of Medicine, The Catholic University of Korea, Seoul, Korea

Address reprint requests to Man Soo Kim, MD, PhD, Department of Ophthalmology, The Catholic University of Korea Seoul St. Mary's Hospital, #222 Banpo-daero, Seocho-gu, Seoul 06591, Korea, Tel: 82-2-2258-1188, Fax: 82-2-599-7405, E-mail: mskim@catholic.ac.kr

Received 5 November 2015 Revised 21 December 2015 Accepted 16 February 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To compare the long-term prognosis of laser in situ keratomileusis (LASIK) and surface ablation in moderate to high myopia.

Methods

A retrospective study including 87 eyes of 44 myopic patients treated with LASIK or surface ablation from 1995 to 2005 was performed. Follow-up visits were performed at 3 months, 1 year, 5 years, and 8 years. All treated eyes were divided into 2 groups according to preoperative spherical equivalent (SE)- moderate myopia (<-6.0 diopters [D]) and high myopia (≥-6.0 D). The main outcome measures were postoperative uncorrected visual acuity (UCVA), best corrected visual acuity, SE, mean keratometry, safety index, efficacy index, predictability, and complications.

Results

Mean SE was −7.05 ± 2.49 D in the LASIK group and −5.25 ± 1.23 D in the surface ablation group. The 10-year SE was −1.78 ± 1.22 D in the LASIK group and −1.35 ± 1.09 D in the surface ablation group, and there was no statistical difference between the 2 groups. At 10 years postoperatively, UCVA was log MAR 0.155 ± 0.161 in the LASIK group and log MAR 0.095 ± 0.140 in the surface ablation group. There were no significant differences in postoperative mean SE, safety index, efficacy index, or complications between the LASIK and surface ablation group at 10 years.

Conclusions

This 10-year follow-up study shows that LASIK and surface ablation for moderate to high myopia have no statistical differences in mean SE, safety index, efficacy index, or complications.

Keywords: Laser epithelial keratomileusis (LASEK), Laser in situ keratomileusis (LASIK), Myopia, Photorefractive keratectomy (PRK), Surface ablation

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Figure 1.

The 10-year-changes in spherical equivalent (mean ± SD) of eyes that underwent refractive surgeries. (A) LASIK. (B) Surface ablation. ‘Group 1’ is ‘low to moderate myopia group with spherical equivalent < −6 D’ and ‘Group 2’ is ‘high myopia group with spherical equivalent ≥ −6 D’. LASIK = laser in situ keratomileusis.

Figure 2.

Bar graph representing predictability of postoperative spherical equivalent (± 1.0 diopters) at each point after refractive surgery. (A) LASIK. (B) Surface ablation. ‘Group 1’ is ‘low to moderate myopia group with spherical equivalent < −6 D’ and ‘Group 2’ is ‘high myopia group with spherical equivalent ≥ −6 D’. LASIK = laser in situ keratomileusis.

Table 1.

Preoperative independent variables

	Total	LASIK	Surface ablation	p-value
	(N = 87 eyes)	(N = 45 eyes)	(N = 42 eyes)	p-value
Age (years, range)	29.77 ± 7.09	30.53 ± 7.49	28.95 ± 6.62	0.377^*
	(19∼46)	(19∼46)	(22∼41)
Sex (male/female)	18/69	11/34	7/35	0.434^†
Spherical equivalent (D, range)	−6.49 ± 2.36	−7.05 ± 2.49	−5.25 ± 1.23	0.000^*
	(-3.25∼–13.75)	(-3.63∼–13.75)	(-3.25∼–8.25)
Degree of cylinder (D, range)	−1.04 ± 0.71	−1.29 ± 0.80	−0.77 ± 0.48	0.001^*
	(0.00∼–3.25)	(0.00∼–3.25)	(0.00∼–1.50)

Values are presented as mean ± SD unless otherwise indicated.

LASIK = laser in situ keratomileusis; D = diopters.

^* Independent t-test;

^† Chi-square test.

Table 2.

Preoperative and postoperative visual results of eyes that underwent LASIK or surface ablation for treatment of myopia

	LASIK (N = 45)		Surface ablation (N = 42)		p-value
	N	Mean ± SD	N	Mean ± SD	p-value
Preop. BCVA (log MAR)		0.021 ± 0.047		0.015 ± 0.042	0.526
Group 1	12	0.000 ± 0.000	12	0.018 ± 0.047	0.032^*
Group 2	33	0.031 ± 0.055	33	0.000 ± 0.000	0.008^*
Preop. UCVA (log MAR)		1.371 ± 0.391		1.188 ± 0.385	0.039^*
Group 1	12	0.983 ± 0.366	12	1.124 ± 0.390	0.282
Group 2	33	1.550 ± 0.249	33	1.450 ± 0.233	0.321
3 months UCVA (log MAR)		0.132 ± 0.173		0.051 ± 0.103	0.013^*
Group 1	12	0.050 ± 0.067	12	0.046 ± 0.103	0.888
Group 2	33	0.169 ± 0.193	33	0.075 ± 0.104	0.199
1 year UCVA (log MAR)		0.116 ± 0.172		0.056 ± 0.136	0.090
Group 1	12	0.025 ± 0.045	12	0.021 ± 0.042	0.793
Group 2	33	0.158 ± 0.192	33	0.200 ± 0.262	0.621
5 years UCVA (log MAR)		0.147 ± 0.191		0.041 ± 0.077	0.003^*
Group 1	12	0.042 ± 0.052	12	0.024 ± 0.044	0.264
Group 2	33	0.196 ± 0.213	33	0.113 ± 0.136	0.305
10 years UCVA (log MAR)		0.155 ± 0.161		0.095 ± 0.140	0.079
Group 1	12	0.058 ± 0.100	12	0.052 ± 0.091	0.829
Group 2	33	0.200 ± 0.165	33	0.275 ± 0.167	0.270

Values are presented as mean ± SD unless otherwise indicated. ‘Group 1’ is ‘low to moderate myopia group with spherical equivalent <-6 D’ and ‘Group 2’ is ‘high myopia group with spherical equivalent ≥-6 D’.

LASIK = laser in situ keratomileusis; Preop. = preoperative; BCVA = best corrected visual acuity; UCVA = uncorrected visual acuity; SD = standard deviation.

^* All p-values between LASIK and surface ablation (SA) group were calculated using paired samples t-test, p < 0.05.

Table 3.

Preoperative and postoperative mean keratometry (K) of eyes that underwent LASIK or surface ablation for treatment of myopia

Groups	No.	Preop. K	p-value	Postop. K (10 years)	p-value
All eyes	87
LASIK	45	43.91 ± 1.63	0.119	40.59 ± 2.69	0.266
SA	42	43.42 ± 1.14		40.06 ± 1.20
Group 1	45
LASIK	12	43.03 ± 1.34	0.616	40.01 ± 1.17	0.878
SA	33	43.24 ± 1.12		39.95 ± 1.23
Group 2	42
LASIK	33	44.19 ± 1.64	0.930	40.87 ± 3.14	0.640
SA	9	44.25 ± 0.88		40.53 ± 0.99

LASIK = laser in situ keratomileusis; Preop. = preoperative; Postop. = postoperative; SA = surface ablation.

Table 4.

Preoperative and postoperative refractive results (SE) of 87 matched eyes that underwent LASIK or surface ablation for treatment of myopia

	LASIK (N = 45)		SA (N = 42)		p-value
	N	Mean ± SD	N	Mean ± SD	p-value
Preop. SE		−7.05 ± 2.49		−5.25 ± 1.23	0.000^*
Group 1	12	−4.44 ± 0.44	33	−4.76 ± 0.69	0.144
Group 2	33	−8.25 ± 2.08	9	−7.28 ± 0.80	0.059
3 months SE		−0.86 ± 0.98		−0.53 ± 0.71	0.091
Group 1	12	−0.51 ± 0.45	33	−0.50 ± 0.78	0.978
Group 2	33	−1.02 ± 1.12	9	−0.64 ± 0.33	0.137
1 year SE		−1.10 ± 0.82		−0.80 ± 0.73	0.093
Group 1	12	−0.51 ± 0.47	33	−0.55 ± 0.46	0.822
Group 2	33	−1.37 ± 0.82	9	−1.84 ± 0.72	0.147
5 years SE		−1.78 ± 1.26		−1.08 ± 0.84	0.006^*
Group 1	12	−0.68 ± 0.65	33	−0.90 ± 0.78	0.379
Group 2	33	−2.28 ± 1.15	9	−1.83 ± 0.65	0.172
10 years SE		−1.78 ± 1.22		−1.35 ± 1.09	0.102
Group 1	12	−0.80 ± 0.75	33	−1.14 ± 1.06	0.316
Group 2	33	−2.23 ± 1.13	9	−2.20 ± 0.77	0.958

SE = spherical equivalent; LASIK = laser in situ keratomileusis; SA = surface ablation; Preop. = preoperative.

^* All p-values between LASIK and SA group were calculated using paired samples t-test, p < 0.05.

Table 5.

Postoperative safety index of eyes that underwent LASIK or surface ablation for treatment of myopia

	N	POD 3 months	POD 1 year	POD 5 years	POD 10 years
LASIK	45	0.85 ± 0.26	0.85 ± 0.32	0.83 ± 0.30	0.80 ± 0.30
SA	42	0.92 ± 0.22	0.96 ± 0.22	0.95 ± 0. 17	0.86 ± 0.30
p-value		0.086	0.051	0.050	0.078
Group 1	45	0.95 ± 0.17	0.99 ± 0.15	0.97 ± 0.14	0.92 ± 0.25
Group 2	42	0.79 ± 0.29	0.78 ± 0.35	0.73 ± 0.30	0.66 ± 0.29
p-value		0.004^*	0.000^*	0.000^*	0.000^*
G1 LASIK	12	0.90 ± 0.13	0.95 ± 0.09	0.91 ± 0.10	0.91 ± 0.17
G1 SA	33	0.96 ± 0.19	1.01 ± 0.16	0.99 ± 0.15	0.92 ± 0.28
p-value		0.320	0.217	0.122	0.884
G2 LASIK	33	0.79 ± 0.27	0.77 ± 0.32	0.77 ± 0.27	0.70 ± 0.28
G2 SA	9	0.84 ± 0.18	0.73 ± 0.32	0.80 ± 0.21	0.61 ± 0.24
p-value		0.672	0.758	0.733	0.398

Total		0.87 ± 0.25	0.89 ± 0.29	0.88 ± 0.26	0.83 ± 0.30

Values are presented as mean ± SD unless otherwise indicated. ‘Group 1 (G1)’ is ‘low to moderate myopia group with spherical equivalent <-6 D’ and ‘Group 2 (G2)’ is ‘high myopia group with spherical equivalent ≥-6 D’.

LASIK = laser in situ keratomileusis; POD = postoperative days; SA = surface ablation.

^* All p-values between LASIK and SA group were calculated using independent t-test, p < 0.05.

Table 6.

Postoperative efficacy index of eyes that underwent LASIK or surface ablation for treatment of myopia

	N	POD 3 months	POD 1 year	POD 5 years	POD 10 years
LASIK	45	0.81 ± 0.23	0.82 ± 0.27	0.82 ± 0.23	0.80 ± 0.24
SA	42	0.94 ± 0.19	0.95 ± 0.23	0.96 ± 0.18	0.85 ± 0.30
p-value		0.011^*	0.035^*	0.004^*	0.083
Group 1	45	0.95 ± 0.17	0.99 ± 0.15	0.97 ± 0.14	0.92 ± 0.25
Group 2	42	0.79 ± 0.24	0.75 ± 0.30	0.78 ± 0.24	0.64 ± 0.24
p-value		0.001^*	0.000^*	0.000^*	0.000^*
G1 LASIK	12	0.90 ± 0.13	0.95 ± 0.09	0.92 ± 0.10	0.90 ± 0.17
G1 SA	33	0.96 ± 0.19	1.01 ± 0.17	0.99 ± 0.15	0.92 ± 0.28
p-value		0.320	0.276	0.122	0.736
G2 LASIK	33	0.77 ± 0.26	0.76 ± 0.31	0.77 ± 0.26	0.66 ± 0.24
G2 SA	9	0.84 ± 0.18	0.71 ± 0.30	0.80 ± 0.21	0.61 ± 0.23
p-value		0.488	0.662	0.725	0.349

Total		0.88 ± 0.22	0.89 ± 0.26	0.89 ± 0.21	0.82 ± 0.28

LASIK = laser in situ keratomileusis; POD = postoperative days; SA = surface ablation.

^* All p-values between LASIK and SA group were calculated using independent t-test, p < 0.05.

Table 7.

Baseline characteristics of 3 cases that developed corneal ectasia after refractive surgery

	Onset	Preop. SE (diopters)	Preop. CCT (μm)	Residual CCT (μm)	Treatment	Final BCVA
Case 1: 1998. 5 LASIK (OD)	POD 7 months	−9.875	454	294	RGP lens	0.32
Case 2: 1995. 12 PRK (OS)	POD 11 months	−8.000	504	378	Observation	0.8
Case 3: 1999. 8 LASIK (OD)	POD 14 years	−9.625	569	420	RGP lens	1.0

Preop. = preoperative; SE = spherical equivalent; CCT = central corneal thickness; BCVA = best corrected visual acuity; LASIK = laser in situ keratomileusis; POD = postoperative days; RGP = rigid gas permeable; PRK = photorefractive keratectomy;.

Table 8.

Complications (cumulative incidence over 10 years) in eyes that underwent LASIK or surface ablation for treatment of myopia

	LASIK (N = 47)		Surface ablation (N = 43)
	N	(%)	N	(%)
Cataract	2	2.22	2	2.22
Corneal ectasia	2	2.22	1	1.11
Corneal haze	0	0	0	0
Dry eye disease	8	8.89	6	6.67
Flap-related complications	0	0	N/A	N/A
Infection	0	0	0	0

LASIK = laser in situ keratomileusis; N/A = not applicable.

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