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Meta-Analysis
. 2014 Jun 17;2014(6):CD007679.
doi: 10.1002/14651858.CD007679.pub4.

Excimer laser refractive surgery versus phakic intraocular lenses for the correction of moderate to high myopia

Allon Barsam  1 , Bruce D S Allan
Affiliations
Meta-Analysis

Excimer laser refractive surgery versus phakic intraocular lenses for the correction of moderate to high myopia

Allon Barsam et al. Cochrane Database Syst Rev. .

Abstract

Background: Myopia is a condition in which the focusing power (refraction) of the eye is greater than that required for clear distance vision. There are two main types of surgical correction for moderate to high myopia; excimer laser and phakic intraocular lenses (IOLs). Excimer laser refractive surgery for myopia works by removing corneal stroma to lessen the refractive power of the cornea and to bring the image of a viewed object into focus onto the retina rather than in front of it. Phakic IOLs for the treatment of myopia work by diverging light rays so that the image of a viewed object is brought into focus onto the retina rather than in front of the retina. They can be placed either in the anterior chamber of the eye in front of the iris or in the posterior chamber of the eye between the iris and the natural lens.

Objectives: To compare excimer laser refractive surgery and phakic IOLs for the correction of moderate to high myopia by evaluating postoperative uncorrected visual acuity, refractive outcome, potential loss of best spectacle corrected visual acuity (BSCVA) and the incidence of adverse outcomes.

Search methods: We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (2014, Issue 1), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to February 2014), EMBASE (January 1980 to February 2014), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 11 February 2014.

Selection criteria: We included randomised controlled trials (RCTs) comparing excimer laser refractive surgery and phakic IOLs for the correction of myopia greater than 6.0 diopters (D) spherical equivalent.

Data collection and analysis: Two authors independently assessed trial quality and extracted data. We performed data analysis. We summarised data for outcomes using odds ratios. We used a fixed-effect model as only three trials were included in the review.

Main results: This review included three RCTs with a total of 228 eyes. The range of myopia of included patients was -6.0 D to -20.0 D of myopia with up to 4.0 D of myopic astigmatism. The percentage of eyes with uncorrected visual acuity (UCVA) of 20/20 or better at 12 months postoperative was not significantly different between the two groups. Phakic IOL surgery was safer than excimer laser surgical correction for moderate to high myopia as it results in significantly less loss of best spectacle corrected visual acuity (BSCVA) at 12 months postoperatively. However there is a low risk of developing early cataract with phakic IOLs. Phakic IOL surgery appears to result in better contrast sensitivity than excimer laser correction for moderate to high myopia. Phakic IOL surgery also scored more highly on patient satisfaction/preference questionnaires.

Authors' conclusions: The results of this review suggest that, at one year post surgery, phakic IOLs are safer than excimer laser surgical correction for moderate to high myopia in the range of -6.0 to -20.0 D and phakic IOLs are preferred by patients. While phakic IOLs might be accepted clinical practice for higher levels of myopia (greater than or equal to 7.0 D of myopic spherical equivalent with or without astigmatism), it may be worth considering phakic IOL treatment over excimer laser correction for more moderate levels of myopia (less than or equal to 7.0 D of myopic spherical equivalent with or without astigmatism). Further RCTs adequately powered for subgroup analysis are necessary to further elucidate the ideal range of myopia for phakic IOLs. This data should be considered alongside comparative data addressing long-term safety as it emerges.

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Conflict of interest statement

None

Figures

1
1
Results from searching for studies for inclusion in the review.
2
2
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
3
3
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
1.1
1.1. Analysis
Comparison 1 Excimer laser versus phakic IOL, Outcome 1 Uncorrected visual acuity of 20/20 or better at 12 months post‐treatment.
1.2
1.2. Analysis
Comparison 1 Excimer laser versus phakic IOL, Outcome 2 UCVA of 20/20 or better at 6 months post‐treatment.
1.3
1.3. Analysis
Comparison 1 Excimer laser versus phakic IOL, Outcome 3 UCVA of 20/40 or better at 6 months post‐treatment.
1.4
1.4. Analysis
Comparison 1 Excimer laser versus phakic IOL, Outcome 4 UCVA of 20/40 or better at 12 months post‐treatment.
1.5
1.5. Analysis
Comparison 1 Excimer laser versus phakic IOL, Outcome 5 Percentage of eyes within ±0.50 D of target refraction at six months post‐treatment.
1.6
1.6. Analysis
Comparison 1 Excimer laser versus phakic IOL, Outcome 6 Percentage of eyes within ±0.50 D of target refraction at 12 months post‐treatment.
1.7
1.7. Analysis
Comparison 1 Excimer laser versus phakic IOL, Outcome 7 Percentage of eyes within ±1.00 D of target refraction at six months post‐treatment.
1.8
1.8. Analysis
Comparison 1 Excimer laser versus phakic IOL, Outcome 8 Percentage of eyes within ±1.00 D of target refraction at 12 months post‐treatment.
1.9
1.9. Analysis
Comparison 1 Excimer laser versus phakic IOL, Outcome 9 Percentage of eyes that lost 2 or more lines of BSCVA at 12 months post‐treatment.
1.10
1.10. Analysis
Comparison 1 Excimer laser versus phakic IOL, Outcome 10 Percentage of eyes that lost 1 or more lines of BSCVA at 6 months post‐treatment.
1.11
1.11. Analysis
Comparison 1 Excimer laser versus phakic IOL, Outcome 11 Percentage of eyes that lost 1 or more lines of BSCVA at 12 months post‐treatment.
See this image and copyright information in PMC

Update of

Comment in

  • December consultation #6.
    Nuñez MX. Nuñez MX. J Cataract Refract Surg. 2015 Dec;41(12):2777-8. doi: 10.1016/j.jcrs.2015.11.031. J Cataract Refract Surg. 2015. PMID: 26796465 No abstract available.
  • December consultation #7.
    Graue Hernandez EO, Hernandez-Bogantes E. Graue Hernandez EO, et al. J Cataract Refract Surg. 2015 Dec;41(12):2778. doi: 10.1016/j.jcrs.2015.11.032. J Cataract Refract Surg. 2015. PMID: 26796467 No abstract available.
  • December consultation #8.
    Kılıç A. Kılıç A. J Cataract Refract Surg. 2015 Dec;41(12):2778. doi: 10.1016/j.jcrs.2015.11.033. J Cataract Refract Surg. 2015. PMID: 26796468 No abstract available.

References

References to studies included in this review

el Danasoury 2002 {published data only}
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Albarran‐Diego 2012 {published data only}
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References to other published versions of this review

Barsam 2008
    1. Barsam A, Allan BDS. Excimer laser refractive surgery versus phakic intraocular lenses for the correction of moderate to high myopia. Cochrane Database of Systematic Reviews 2010, Issue 5. [DOI: 10.1002/14651858.CD007679.pub2] - DOI - PubMed
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