Photorefractive Keratectomy Versus Laser-Assisted In Situ Keratomileusis For Mixed Astigmatism

To compare the visual and refractive outcomes of photorefractive keratectomy (PRK) and laser-assisted in situ keratomileusis (LASIK) for the treatment of mixed astigmatism.

Care Vision Laser Center, Tel Aviv, Israel.

This retrospective matched comparative study included consecutive patients aged 17 to 60 years who underwent PRK or LASIK for mixed astigmatism (spherical error of ≥ +0.50 D and spherical equivalent < 0.00 D) between 2013 and 2022. Matching was performed for age, gender, spherical equivalent (SE), sphere, cylinder, and year of surgery. A total of 82 eyes included in each group. Inclusion required a postoperative follow-up of at least 30 days for LASIK and 90 days for PRK. Preoperative, intraoperative, and postoperative visual and refractive parameters were analyzed and compared between the groups.

Mean preoperative cylinder and SE were comparable. Preoperative best-corrected visual acuity (BCVA) was higher for LASIK (0. 04±0.05 versus 0.06±0.07, P=0.023). Intraoperative parameters were comparable between the groups. Postoperative uncorrected visual acuity (UCVA) was 0.10±0.17 LogMAR for PRK and 0.06±0.11 LogMAR for LASIK (P=0.043), while BCVA was 0.04±0.07 and 0.02±0.04 LogMAR, respectively (P=0.034). Postoperative cylinder was lower in LASIK (-0.47±0.46 D) than PRK (-0.77±0.66 D, P=0.002). Measures of refractive accuracy, including index of success and cylinder correction, were slightly better in LASIK, with a significant difference in deviation vector (P=0.01). Both procedures demonstrated high safety and efficacy indices (P>0.05).

Both PRK and LASIK provide effective and safe refractive outcomes for mixed astigmatism. LASIK demonstrated slight superiority in postoperative visual acuity and cylinder correction, while PRK remains a viable alternative.