Eight-Year Outcomes Of Keratorefractive Lenticule Extraction For High Myopia Over -10 Diopters With Or Without Mild Astigmatism

To investigate the long-term outcomes of keratorefractive lenticule extraction (KLEx) for correcting myopia greater than 10 diopters (D).

Department of Ophthalmology, EENT Hospital of Fudan University, Shanghai, China

Patients with myopia refractive error over 10 D with or without astigmatism underwent KLEx were included. The corrected distance visual acuity (CDVA), uncorrected distance visual acuity (UDVA), keratometry, thinnest corneal thickness (TCT), posterior central elevation (PCE), and axial length (AL) were analyzed preoperatively and 1 day and 8 years postoperatively.

Thirty-two eyes with a mean SE of –11.13 ± 0.67 D were included.Overall, 27 of 32 eyes underwent an under-correction strategy due to corneal thickness limitation. After 8 years, the safety and efficacy indices were 1.02 ± 0.19 and 0.53 ± 0.33, respectively. The CDVA remained unchanged or increased in 29 eyes (91%), but 3 eyes (9%) lost one or two lines. Nineteen eyes (59%) were corrected within ±1.0 D of the target, and 18 eyes (56%) had a LogMAR value of ≥0.3 for UDVA. Mean regression over 8 years was –1.17 ± 1.22 D. TCT and keratometry values increased significantly from 1 day to 8 years (P <0.05). PCE remained stable during the follow-up period; however, AL significantly increased 8 years after KLEx compared to baseline values (P <0.05).

KLEx with a probable under-correction strategy could be a viable alternative for patients with high myopia over 10 D with or without astigmatism under strict preoperative assessment and appropriate surgical design. Patients should be informed of increased refractive regression risk over time.