Visual Outcomes And Safety Of Ray-Tracing-Guided Laser-Assisted In Situ Keratomileusis: A Systematic Review And Meta-Analysis

Published 2026 - 44th Congress of the ESCRS

Reference: PP10.07 | Type: Free paper | DOI: 10.82333/681t-p607

Authors: Dr Maximilian Friedrich* ¹ , A/Prof. Victor Augustin ¹ , A/Prof. Gerd Auffarth ¹ , A/Prof. Ramin Khoramnia ² , A/Prof. Hyeck-Soo Son ¹

¹David J. Apple International Laboratory for Ocular Pathology and International Vision Correction Research Centre (IVCRC), Department of Ophthalmology,University of Heidelberg,Heidelberg,Germany, ²Department of Ophthalmology,Faculty of Medicine and University Hospital Carl Gustav Carus, TU Dresden,Dresden,Germany

Purpose

RTG-LASIK is one of the most modern approaches in refractive surgery using only objective and automated measurements promising to improve visual outcomes. The aim of this analysis was to evaluate the visual outcome and safety profile after ray-tracing-guided laser-assisted in situ keratomileusis (RTG-LASIK) for myopia with or without astigmatism.

Setting

Systematic literature review and meta-analysis at a tertiary eye hospital.

Methods

In this systematic review and meta-analysis original peer-reviewed clinical studies on the visual outcomes of RTG-LASIK in eyes with myopia +/- astigmatism were included. The risk of bias was assessed using ROBINS-I. Primary effect measures were the proportions of eyes achieving 20/20 uncorrected distance visual acuity (UDVA) and losing ≥1 line of corrected distance visual acuity (CDVA) after RTG-LASIK. Secondary outcomes included changes in Snellen lines for CDVA and UDVA relative to preoperative CDVA, postoperative manifest refraction spherical equivalent (MRSE), higher-order aberrations (HOAs) as well as other refractive parameters, synthesized using a random-effects model. In addition, postoperative complications were documented.

Results

In total, 14 clinical studies with a total of 1577 eyes were included. The pooled percentage of eyes with postoperative UDVA ≥20/20 was 99.17% (95%CI: 95.75%,99.84%;I²=47.4%). Loss of ≥1 line in CDVA after RTG-LASIK occurred in 2.21% (95%CI: 1.07%,4.52%;I²=38.5%). CDVA showed an improvement in nearly half of all cases. In addition, postoperative UDVA tended to improve compared to preoperative CDVA. MRSE was within 0.5D of target refraction in 95.21% but showed a slight trend towards overcorrection. Total HOAs increased slightly by 0.087µm (95%CI: 0.027,0.148;I²=97.5%), while spherical aberration and trefoil tended to decrease after RTG-LASIK. The studies reported nine refractive retreatments and a generally favorable complication profile.

Conclusions

This meta-analysis suggests that RTG-LASIK may be a safe and effective procedure for improving UDVA and CDVA in selected myopic eyes in the short term, with relatively low reported complication rates. However, larger prospective studies with longer follow-up are needed to confirm these findings and better define long-term safety and efficacy.