Contents

Laser-assisted in situ keratomileusis (LASIK)

Edited by:

Last updated: May 17th, 2022

Menu

Summary of Evidence

Evidence

1. General

2. Comparison of techniques

2.1. Myopia

2.1.1. LASIK vs SMILE

Meta-analysis

2021 Fu et.al.

Article link | Metrics cited by count

2021
Meta-analysis

For patients with high myopia, both small-incision lenticule extraction (SMILE) and femtosecond laser-assisted-LASIK are safe, efficacious and predictable. However, the SMILE group demonstrated advantages over the FS-LASIK group in terms of postoperative CDVA, while SMILE induced less aberration than FS-LASIK.{Fu Y, Yin Y, Wu X, Li Y, Xiang A, Lu Y, Fu Q, Hu T, Du K, Wen D. Clinical outcomes after small-incision lenticule extraction versus femtosecond laser-assisted LASIK for high myopia: A meta-analysis. PLoS One. 2021 Feb 8;16(2):e0242059. }

Meta-analysis included twelve studies involving 766 patients (1400 eyes: 748 receiving SMILE and 652 receiving FS-LASIK).

Fu et.al.
Pubmed Journal full text Metrics

cited by count
Clinical trial

2020 Ang et.al.

Article link | Metrics cited by count

2020
Clinical trial

The results from this randomized trial comparing femtosecond LASIK and SMILE in myopia and myopic astigmatism suggest that SMILE produced promising refractive outcomes in terms of predictability, efficacy, and safety at 3 and 12 months of follow-up.{Ang M, Farook M, Htoon HM, Mehta JS. Randomized Clinical Trial Comparing Femtosecond LASIK and Small-Incision Lenticule Extraction. Ophthalmology. 2020 Jun;127(6):724-730.}

At 3 months, 99% of SMILE eyes and 97% of LASIK eyes achieved SE within ±1.0 D of attempted correction. Small-incision lenticule extraction achieved similar results as LASIK in terms of efficacy index, uncorrected distance visual acuity (UDVA) of 20/40 or better, and UDVA of 20/20 or better.

Safety index  was similar between SMILE and LASIK eyes at 3 months.

At 12 months, SMILE was similar to LASIK in terms of efficacy, predictability, and safety.

Ang et.al.
Pubmed Journal full text Metrics

cited by count
Review

2016 Zhang et.al.

Article link | Metrics cited by count

2016
Review

SMILE and FS-LASIK were comparable in terms of both safety and efficacy. SMILE may create fewer dry eye symptoms than FS-LASIK. Corneal sensitivity was greater after SMILE than FS-LASIK.{Zhang Y, Shen Q, Jia Y, Zhou D, Zhou J. Clinical Outcomes of SMILE and FS-LASIK Used to Treat Myopia: A Meta-analysis. J Refract Surg. 2016 Apr;32(4):256-65. }

Zhang et.al.
Pubmed Journal full text Metrics

cited by count

2.1.2. LASIK vs PRK

Systematic review

2013 Shortt et.al. (Cochrane)

Article link | Metrics cited by count

2013
Systematic review

LASIK gives a faster visual recovery and is a less painful technique than PRK. The two techniques appear to give similar outcomes one year after surgery.{Shortt AJ, Allan BD, Evans JR. Laser-assisted in-situ keratomileusis (LASIK) versus photorefractive keratectomy (PRK) for myopia. Cochrane Database Syst Rev. 2013 Jan 31;(1):CD005135.}

Analysis of 13 trials (1135 participants, 1923 eyes)

Shortt et.al. (Cochrane)
Pubmed Journal full text Metrics

cited by count
Review

2006 Shortt et.al.

Article link | Metrics cited by count

2006
Review

LASIK appears to have efficacy and safety superior to those of PRK.{Shortt AJ, Bunce C, Allan BD. Evidence for superior efficacy and safety of LASIK over photorefractive keratectomy for correction of myopia. Ophthalmology. 2006 Nov;113(11):1897-908. }

Shortt et.al.
Pubmed Journal full text Metrics

cited by count

2.1.3. LASIK vs LASEK

Systematic review

2017 Kuryan et.al. (Cochrane)

Article link | Metrics cited by count

2017
Systematic review

There is uncertainty in how LASEK compares with LASIK in achieving better refractive and visual results in mildly to moderately myopic participants.{Kuryan J, Cheema A, Chuck RS. Laser-assisted subepithelial keratectomy (LASEK) versus laser-assisted in-situ keratomileusis (LASIK) for correcting myopia. Cochrane Database Syst Rev. 2017 Feb 15;2(2):CD011080. }

Analysis of  three trials (154 participants).

Kuryan et.al. (Cochrane)
Pubmed Journal full text Metrics

cited by count

2.2. Hyperopia

2.2.1. LASIK vs PRK

Systematic review

2012 Settas et.al. (Cochrane)

Article link | Metrics unavailable

2012
Systematic review

No robust, reliable conclusions could be reached, but the non-randomised trials reviewed appear to be in agreement that hyperopic-PRK and hyperopic-LASIK are of comparable efficacy.{Settas G, Settas C, Minos E, Yeung IY. Photorefractive keratectomy (PRK) versus laser assisted in situ keratomileusis (LASIK) for hyperopia correction. Cochrane Database Syst Rev. 2012 Jun 13;2012(6):CD007112.}

Settas et.al. (Cochrane)
Pubmed Journal full text Metrics

unavailable

3. Surgical technique

3.1. Mechanical microkeratome vs femtosecond laser

Systematic review

2020 Kahuam-Lopez et.al.

Article link | Metrics cited by count

2020
Systematic review

Regarding the visual acuity outcomes, there may be no difference between LASIK with mechanical microkeratome and LASIK with femtosecond laser.

Dry eye and diffuse lamellar keratitis are likely adverse events with mechanical microkeratome and femtosecond laser, respectively.

The evidence is uncertain regarding corneal haze and epithelial ingrowth as adverse events of each intervention.{Kahuam-López N, Navas A, Castillo-Salgado C, Graue-Hernandez EO, Jimenez-Corona A, Ibarra A. Laser-assisted in-situ keratomileusis (LASIK) with a mechanical microkeratome compared to LASIK with a femtosecond laser for LASIK in adults with myopia or myopic astigmatism. Cochrane Database Syst Rev. 2020 Apr 7;4(4):CD012946. }

Kahuam-Lopez et.al.
Pubmed Journal full text Metrics

cited by count

4. Complications

4.1. Post-LASIK ectasia

Review

2019 Ambrosio Jr

Article link | Metrics cited by count

2019
Review

Review of post-LASIK ectasia:

Ectasia occurs due to biomechanical decompensation of the stroma, which may be related to a severe impact on corneal structure (i.e., attempted treatment for high myopia) or the altered biomechanical properties preoperatively. The current understanding is that a combination from those factors determines stability or ectasia progression after LVC. {Ambrósio R Jr. Post-LASIK Ectasia: Twenty Years of a Conundrum. Semin Ophthalmol. 2019;34(2):66-68. }

Ambrosio Jr
Pubmed Journal full text Metrics

cited by count

4.2. Dry Eye

Review

2018 Toda

Article link | Metrics cited by count

2018
Review

Review of Dry eye after LASIK.{Toda I. Dry Eye After LASIK. Invest Ophthalmol Vis Sci. 2018 Nov 1;59(14):DES109-DES115.}

Toda
Pubmed Journal full text Metrics

cited by count

References

Comments

Subscribe
Notify of
guest
0 Comments
Inline Feedbacks
View all comments

© 2024 - sourceshed