Comparison between the change in total corneal astigmatism and actual change in refractive astigmatism in transepithelial photorefractive keratectomy (tPRK), laser in situ keratomileusis (LASIK) and femtosecond laser assisted laser in situ keratomileusis (FsLASIK)

Author:

Bohac Maja1ORCID,Biscevic Alma1ORCID,Shijakova Violeta12,Gabric Ivan1,Gabric Kresimir1,Patel Sudi1

Affiliation:

1. Specialty Eye Hospital “Svjetlost”, Zagreb, Croatia, School of Medicine University of Rijeka, Croatia

2. Eye Clinic Sistina Oftalmologija, Skopje, Republic of North Macedonia

Abstract

Purpose To compare changes in astigmatism by refraction and total corneal astigmatism after tPRK, LASIK and FsLASIK. Setting Specialty Eye Hospital Svjetlost, Zagreb, Croatia. Design Partially masked, semi-randomized, prospective, case-by-case, interventional, clinical study. Methods Patients with a stable refraction (-0.75DS to −8.00DS, astigmatism ≤1.00DC) underwent tPRK, LASIK or FsLASIK without complication. Astigmatism was measured at both corneal surfaces over the central 3.2 mm zone (approximately using Pentacam HRTM) preoperatively and 3 months postoperatively. Pentacam and refraction data were subjected to vector analysis to calculate the surgically induced changes in i) total corneal astigmatism (SIATCA) ii) any astigmatism by refraction (SIAR) and the vectorial difference (DV) between SIATCA and SIAR. Results Reporting key findings (p < .01), there was a significant difference between mean SIATCA and SIAR powers after tPRK (75eyes) but not after LASIK (100eyes) or FsLASIK (100eyes). Mean (±sd,95% CIs) values for DV powers were, tPRK −1.13DC(±0.71, −1.29 to −0.97), LASIK −0.39DC(±0.23,-0.44 to −0.34), FsLASIK −0.55DC(±0.38,-0.62 to −0.47). The differences were significant. For the tPRK and FsLASIK cases, linear regression revealed significant associations between I) SIATCA (x) &DV (z) powers (tPRK z = 1.586x-0.179, r  =  0.767, p < .01; FsLASIK z  =  0.442x-0.303, r  =  .484,p < .01), II) sines of SIATCA (x1) &DV (z1) axes (tPRK, z1 = 0.523 × 1 + 0.394, r = .650,p < .01; FsLASIK z1 = 0.460 × 1-0.308, r = .465,p < .01). Conclusions tPRK is more prone to unintended changes in astigmatism. The difference between SIATCA & SIAR after tPRK or FsLASIK is mediated by SIATCA. Photoablating deeper regions of the cornea reduces the gap between SIATCA & SIAR.

Publisher

SAGE Publications

Subject

Ophthalmology,General Medicine

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