Uncorrected and Corrected Distance Visual Acuity, Predictability, Efficacy, and Safety after Femtosecond Laser in Situ Keratomileusis (FS-LASIK) and Refractive Lenticule extraction (ReLEx) for Moderate and High Myopia
Title: Uncorrected and Corrected Distance Visual Acuity, Predictability, Efficacy, and Safety after Femtosecond Laser in Situ Keratomileusis (FS-LASIK) and Refractive Lenticule extraction (ReLEx) for Moderate and High Myopia. Vestergaard A., Justesen B., Melsen C., Lyhne N., Department of Ophthalmology, Odense University Hospital, Denmark. Purpose: ReLEx is a relative new corneal refractive procedure, where a stromal lenticule is cut by a femtosecond laser and manually extracted. The purpose of this study was to compare uncorrected and corrected distance visual acuity (UDVA and CDVA), refractive predictability, efficacy and safety after femtosecond LASIK (FS-LASIK) with ReLEx. Setting: Department of Ophthalmology, Odense University Hospital, Denmark. Methods: Retrospective study of results after FS-LASIK and ReLEx (including ReLEx flex, ReLEx pseudo-smile, and ReLEx smile). In total, 228 eyes were treated with FS-LASIK and 83 eyes with ReLEx, at the Department of Ophthalmology, Odense University Hospital in the period of April to November 2011. Only otherwise healthy myopic eyes with up to 3.00 D of astigmatism and with CDVA ≤ 0.30 (logMAR) before surgery were included in this study. FS-LASIK flaps and ReLEx treatments were made with a VisuMax® femto-second laser (Carl Zeiss-Meditec, Jena, Germany). In FS-LASIK, the photoablation was performed with a MEL-80 flying spot excimer laser (Carl Zeiss-Meditec, Jena, Germany). In ReLEx, lenticule diameter was 6.50 mm, whereas the FS-LASIK ablation zone diameter was 6.00 mm. In all patients, flap thickness was 105-120 µm. Clinical examinations were performed preoperatively and at day 1, 1 week and 3 months after surgery. Results: Preoperative spherical equivalent refraction averaged -7.23 ± 2.27 D for FS-LASIK and -7.56 ± 1.73 D for ReLEx eyes. In total, 183 FS-LASIK eyes (80%) and 60 ReLEx eyes (72%) completed the 3 month follow-up. For eyes with emmetropia as target refraction: At day 1 after surgery, 87 % of FS-LASIK and 43 % of ReLEx eyes had an UDVA ≤ 0.1(logMAR). After 3 months, the results were 76 % for FS-LASIK and 79 % for ReLEx. For all eyes, 91 % of FS-LASIK eyes and 98 % of ReLEx eyes were within ± 1.0 D of the intended correction. Seventy-eight percent of FS-LASIK eyes and 82 % of ReLEx eyes were within ± 0.50 D of the intended correction after 3 months. Also, the mean difference in attempted vs. achieved spherical equivalent (SE) refraction was -0.17 ± 0.67 D for FS-LASIK and 0.13 ± 0.55 D for ReLEx 3 months after surgery. For FS-LASIK, mean CDVA (logMAR) before surgery was 0.00 ± 0.08 D, and after 3 months -0.02 ± 0.08 D. For ReLEx it was -0.01 ± 0.07 D both before and 3 months after surgery. All eyes had CDVA ≤ 0.2 (logMAR) 3 months after surgery. Conclusions: Both FS-LASIK and ReLEx are efficient in treating myopia and myopic astigmatism. ReLEx is a promising new all-in-one femtosecond laser refractive procedure with results, concerning predictability and efficacy, that seemed comparable to or better than FS-LASIK after 3 months, although recovery of vision after ReLEx surgery seemed slower. Financial disclosures: None.