Comparison of Corneal Higher-Order Aberrations Following Topography-Guided LASIK and SMILE for Myopic Correction: A Propensity Score Matching Analysis

• Published in: Journal of clinical medicine Vol. 11; no. 20; p. 6171
• Main Authors: Kang, Eun Min, Ryu, Ik Hee, Lee, In Sik, Kim, Jin Kuk, Kim, Sun Woong, Ji, Yong Woo
• Format: Journal Article
• Language: English
• Published: Basel MDPI AG 19.10.2022; MDPI
• Subjects: Ablation; Astigmatism; Clinical medicine; Coma; Cornea; Electronic health records; Lasers; Medical records; Patients; Software; Surgery; Topography; United States > US; Germany
• ISSN: 2077-0383; 2077-0383
• DOI: 10.3390/jcm11206171

Ocular aberrations, particularly corneal higher-order aberrations (HOAs), which impair visual quality, should be minimized or corrected during any laser vision correction. We compared changes in visual outcomes, including HOAs, in patients who underwent Topography-Guided laser-assisted in situ keratomileusis (TG-LASIK) or small-incision lenticule extraction (SMILE) after propensity score matching (PSM) to reduce selection bias. Of 2749 patients who underwent SMILE or TG-LASIK for myopia, 152 eyes underwent complete ophthalmic examination preoperatively and over six months postoperatively. Visual outcomes were comparatively analyzed after PSM. As a result, 45 eyes were included in each group after PSM. There was a comparable improvement in visual acuity (VA) and refractive parameters postoperatively, with no difference between the two PSM-groups. However, 6.6% in the SMILE PSM-group lost two or more lines of Snellen VA at the six-month follow-up, while none in the TG-LASIK PSM-group did. Specifically, the SMILE PSM-group showed a significant increase in corneal HOAs, including spherical aberration, coma, and total HOAs (0.0736 ± 0.162 μm; 0.181 ± 0.233 μm; and 0.151 ± 0.178 μm, respectively), whereas TG-LASIK PSM-group did not. Furthermore, SMILE PSM-group had greater postoperative corneal HOAs than those in TG-LASIK PSM-group. Collectively, TG-LASIK induces fewer corneal HOAs even after facilitating between-group comparability using PSM analysis. TG-LASIK provides better visual quality than SMILE for myopia.