Prospective randomized comparison of wavefront-guided and conventional photorefractive keratectomy for myopia with the meditec MEL 70 laser.
OBJECTIVE
To study refractive results and aberrometric changes in myopic patients treated with wavefront-guided photorefractive keratectomy (PRK) in comparison with standard PRK.


METHODS
Sixty eyes of 60 patients with myopic astigmatism were randomly divided into two groups. Group 1 included 30 eyes (mean spherical equivalent refraction -4.39 +/- 1.31 D; range -2.50 to -6.50 D) treated with wavefront-guided PRK using the WASCA workstation and the Asclepion Meditec flying spot MEL 70 excimer laser. Group 2 had 30 eyes (mean spherical equivalent refraction -4.33 +/- 1.22 D; range -2.50 to -6.50 D) that underwent conventional PRK using the same laser, and served as the control group. Wavefront analysis of high order aberrations was performed before and 6 months after surgery.


RESULTS
Postoperatively, wavefront error increased in both groups (5.0-mm wavefront aperture diameter). Six months after surgery, the eyes that received the WASCA ablation had a smaller increase in root-mean-square (RMS; 70% of increment) compared to the conventional PRK group (139% of increment) (P<.001). In the standard PRK group, all aberrations notably increased; in the wavefront-guided PRK group there was a smaller increase of trefoil and spherical aberrations (P<.001) and a decrease of coma aberrations (P<.001). The smaller increase of wavefront error in the wavefront-guided PRK group compared to the standard PRK group was more evident when preoperative RMS values were higher than 0.4 microm (P<.01). The visual parameters (spherical equivalent refraction, uncorrected and best spectacle-corrected visual acuity) did not show significant differences between the two groups.


CONCLUSIONS
Wavefront-guided PRK induced a smaller increase of postoperative wavefront-error compared to conventional PRK, particularly in patients with higher preoperative higher order aberrations.
Mastropasqua
Leonardo
L
Department of Medicine and Aging Science and Section of Ophthalmology, University of Chieti, Italy. mastropa@phobos.unich.it
Nubile
Mario
M
Ciancaglini
Marco
M
Toto
Lisa
L
Ballone
Enzo
E
D000328:Adult; D016022:Case-Control Studies; D019781:Corneal Topography; D006801:Humans; D053685:Laser Therapy; D054018:Lasers, Excimer; D009216:Myopia / Q000601:surgery*; D018903:Photorefractive Keratectomy / Q000379:methods*; D011446:Prospective Studies; D012029:Refraction, Ocular; D016896:Treatment Outcome; D014792:Visual Acuity