Comparative Outcomes And Functional Complication Grading Of Photorefractive Keratectomy Vs. Femtosecond Laser-Situ In Keratomileusis: A Propensity Score-Matched Real-World Large-Scale Retrospective Analysis
Published 2026 - 44th Congress of the ESCRS
Reference: FP07.01 | Type: Free paper | DOI: 10.82333/sfcb-4594
Authors: Dr Avinoam Shye Shahar* 1 , A/Prof. Asaf Achiron 2 , Dr Tomer Batash 3 , Dr Eliya Levinger 2 , Mr Tzachi Sela 4 , Mr Gur Munzer 4 , Dr Shmuel Levinger 5 , A/Prof. Michael Mimouni 6 , A/Prof. David Smadja 3
1Ophthalmology,Rambam Health Care Campus,Haifa,Israel, 2Ophthalmology,Tel Aviv Sourasky Medical Center,Tel Aviv,Israel;Enaim Refractive Surgery Centers,Tel Aviv,Israel, 3Ophthalmology,Hadassah Medical Center,Jerusalem,Israel;Ein-Tal Hadassah Laser Institute,Tel Aviv,Israel, 4Care-Vision Laser Center,Tel Aviv,Israel, 5Enaim Refractive Surgery Centers,Tel Aviv,Israel, 6Ophthalmology,Rambam Health Care Campus,Haifa,Israel;Ruth and Bruce Rappaport Faculty of Medicine,Technion - Israel Institute of Technology,Haifa,Israel;Care-Vision Laser Center,Tel Aviv,Israel
Purpose
To evaluate the efficacy, safety, and complication profiles of primary photorefractive keratectomy (PRK) versus femtosecond LASIK (FemtoLASIK). Because PRK is frequently selected for younger patients with more myopic eyes, inherent selection bias exists in real-world data. This study introduces a novel 3-Tier Functional Complication Grading system to differentiate between transient, repairable, and permanent adverse events, and utilizes statistical matching to compare true procedure outcomes.
Setting
A nationwide, real-world large-scale retrospective cohort analysis of primary laser vision correction procedures performed between 2014 and 2024.
Methods
Clinical data from 85,623 consecutive primary myopic treatments (SEQ ≤ -0.50 D, CDVA > 0.5) were analyzed (68,900 PRK; 16,723 FemtoLASIK). Efficacy and postoperative visits were evaluated using a 1:1 PSM cohort to account for baseline differences. Complications were analyzed using the full cohort to capture rare events, graded by functional impact: Grade 1 (early/transient), Grade 2 (repairable with intervention), and Grade 3 (permanent loss of ≥ 2 lines CDVA).
Results
In the PSM cohort, FemtoLASIK achieved superior UDVA 20/20 (68.5% vs. 54.0% PRK) and predictability within ±0.50D (90.1% vs. 87.4%). Conversely, PRK had a significantly lower retreatment rate (0.57% vs. 1.22%). Postoperative burden (4+ visits) was higher for PRK (33.6%) than FemtoLASIK (11.2%). In the full cohort, permanent vision loss (Grade 3) was extremely rare (FemtoLASIK 0.10%, PRK 0.09%). FemtoLASIK had higher rates of Grade 1 (14.72% vs. 8.89%) and Grade 2 repairable events (0.66% vs. 0.25%).
Conclusions
Both modalities demonstrate exceptional safety, with permanent vision loss occurring in ≤ 0.1% of myopic cases. While FemtoLASIK provides superior primary visual outcomes, PRK yields a lower retreatment rate. Importantly, our matched analysis reveals this lower rate is partly driven by a higher subjective threshold for secondary surface intervention and a greater tolerance for residual refractive error, rather than superior primary surgical accuracy or anatomical limitations.