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Postoperative efficacy, predictability, safety and visual quality of laser corneal refractive surgery: a network meta-analysis

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Session Details

Session Title: Presented Poster Session: Keratorefractive Results I

Venue: Poster Village: Pod 2

First Author: : C.McAlinden UK

Co Author(s): :                  

Abstract Details

Purpose:

To systematically compare the post-operative efficacy, predictability, safety and visual quality of all major forms of laser corneal refractive surgeries for correcting myopia and to provide evidence-based rankings of these treatments.

Setting:

Multi-centre network meta-analysis.

Methods:

A systematic literature retrieval in in the MEDLINE, EMBASE, Cochrane Library and the US trial registry (www.ClinicalTrials.gov) was conducted to include randomized controlled trials (RCTs) which included two or more different refractive surgeries to correct myopia up to November 2015. Bayesian network meta-analyses were performed to identify different refractive surgical procedures. Outcome Measures: Efficacy (uncorrected visual acuity [UCVA]), predictability (refractive spherical equivalent (SE)) and safety (best spectacle corrected visual acuity [BSCVA]) as primary visual outcomes and higher order aberrations (HOAs) and contrast sensitivity (CS) as secondary outcomes. A total of 48 RCTs involving 3067 patients were included.

Results:

Efficacy: there were no statistically significant differences between any pair of treatments. The SUCRA ranking (best-worst) was: FS-LASIK, LASIK, SMILE, FLEx, PRK, LASEK, Epi-LASIK, T-PRK. Predictability: a statistical significant difference was found when FS-LASIK was compared with LASIK (OR 2.29, 95%CI 1.20–4.14), PRK (OR 2.16, 95%CI 1.15–4.03), LASEK (OR 2.09, 95%CI 1.08–4.55), and Epi-LASIK (OR 2.74, 95%CI 1.11–6.20). The SUCRA ranking (best-worst) was: FS-LASIK, T-PRK, LASEK, PRK, LASIK, Epi-LASIK. Safety: There were no statistically significant differences in the comparisons. For both post-operative HOAs and CS, there were no statistically significant differences between any pair of treatments.

Conclusions:

This network meta-analysis shows that corneal stromal ablation surgery, especially FS-LASIK, has better results in three visual outcomes (efficacy, predictability and safety) compared with other types of surgeries, but for the results describing visual quality (HOAs and CS), some corneal surface ablation techniques exhibit better performance.

Financial Disclosure:

NONE

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