Femtosecond laser versus mechanical microkeratome laser in situ keratomileusis for myopia: Metaanalysis of randomized controlled trials

Abstract

Purpose: To examine differences in efficacy, accuracy, safety, and changes in aberrations between femtosecond and mechanical microkeratome laser in situ keratomileusis (LASIK) for myopia.

Setting: Department of Ophthalmology, Shanghai First People's Hospital Affiliated to Shanghai Jiaotong University, Shanghai, China.

Design: Evidence-based manuscript.

Methods: Data sources, including PubMed, Medline, EMBASE, and Cochrane Controlled Trials Register, were searched to identify potentially relevant prospective randomized controlled trials. Primary outcome measures were efficacy (uncorrected distance visual acuity ≥20/20), accuracy (±0.50 diopter mean spherical equivalent), and safety (loss of ≥2 lines of corrected distance visual acuity). Aberrations and postoperative complications were secondary outcomes.

Results: Seven prospective randomized controlled trials describing a total of 577 eyes with myopia were included in this metaanalysis. At 6 months or more follow-up, no significant differences were found in the efficacy (odds ratio [OR], 1.17; 95% confidence interval [CI], 0.40 to 3.42; P=.78), accuracy (OR, 1.69; 95% CI, 0.68 to 4.20; P=.26), or safety (OR, 7.37; 95% CI, 0.37 to 147.61; P=.19). In eyes that had femtosecond LASIK, the postoperative total aberrations (mean difference -0.03 μm; 95% CI, -0.05 to -0.01; P=.002) and spherical aberrations (mean difference -0.02 μm; 95% CI, -0.03 to -0.01; P<.00001) were significantly lower.

Conclusions: According to the metaanalysis, femtosecond LASIK did not have an advantage in efficacy, accuracy, and safety measures over mechanical microkeratome LASIK in the early and midterm follow-up, although it might induce fewer aberrations.