Refractive outcome of wavefront guided laser in situ keratomileusis and wavefront guided photorefractive keratectomy in high pre-existing higher order aberration

• WF-LASIK and WF-PRK showed similar results in terms of efficacy, safety and predictability.
• WF-PRK eyes showed better contrast sensitivity values than WF-LASIK eyes.
• There was trend of lesser induction of HOAs in WF-PRK Group vs. WF-LASIK group.
• WF-PRK may be preferred in highly aberrated corneas over WF-LASIK.

PurposeTo compare visual outcome and higher order aberrations (HOA) between wavefront-guided LASIK (WF-LASIK) and wavefront guided PRK (WF-PRK) in patients with high preoperative HOA.MethodsRandomized prospective interventional study. Conducted at Guru Nanak Eye Centre, Maulana Azad Medical College, Delhi, India. Eighty myopic eyes of forty patients were included. Inclusion criteria: age more than 21 years, best corrected visual acuity of 20/20 or better, a stable refraction, to be off soft contact lens for minimum 14 days prior to preoperative examination, preoperative RMS HOA more than 0.35 μ, preoperative central corneal thickness at least 500 μm, estimated residual stromal bed thickness of at least 275 μm in patients undergoing WF-LASIK and 350 μm in patients undergoing WF-PRK. Exclusion criteria were severe dry eye, blepharitis, corneal disease and warpage, uveitis, posterior segment abnormalities involving the macula or optic nerve and systemic diseases. Patients were randomly divided into two groups. They underwent either WF-LASIK (group A) or WF-PRK (group B) over 2 years (40 eyes each). Patients were followed up for 6 months. Main outcome measures were efficacy, safety, stability, predictability and HOA.ResultsAt 6 months mean uncorrected visual acuity (logMAR) in group A was −0.01 ± 0.04 and group B was 0.00 ± 0.07 (P = 0.23). HOA RMS (6 mm pupil) in group A was 0.61 ± 0.24 μm and group B was 0.55 ± 0.25 μm. The increase was statistically significant in both the groups (P < 0.05). Both the groups showed similar efficacy, predictability and safety.ConclusionWF-LASIK and WF-PRK have similar efficacy, safety and predictability, though WF-PRK induces less HOA.