Postoperative Efficacy, Predictability, Safety, and Visual Quality of Laser Corneal Refractive Surgery: A Network Meta-analysis.
OBJECTIVE
To compare the postoperative efficacy, predictability, safety, and visual quality of all major forms of laser corneal refractive surgeries for correcting myopia.


METHODS
Systematic review and network meta-analysis.


METHODS
Search of MEDLINE, EMBASE, Cochrane Library, and the US trial registry was conducted up to November 2015. Randomized controlled trials (RCT) reporting in accordance with the eligibility criteria were included in this review. We performed a Bayesian random-effects network meta-analysis.


RESULTS
Forty-eight RCTs were identified. For efficacy (uncorrected visual acuity [UCVA]), there were no statistically significant differences between any pair of treatments analyzed. The SUCRA (surface under the cumulative ranking curve) ranking (from best to worst) was femtosecond-based laser in situ keratomileusis (FS-LASIK), LASIK, small-incision lenticule extraction, femtosecond lenticule extraction (FLEx), photorefractive keratectomy (PRK), laser epithelial keratomileusis (LASEK), epipolis (Epi)-LASIK, transepithelial PRK (T-PRK). For predictability (refractive spherical equivalent [SE]), a statistically significant difference was found when FS-LASIK was compared with LASIK (odds ratio [OR] 2.29, 95% credible interval [CrI] 1.20-4.14), PRK (OR 2.16, 95% CrI 1.15-4.03), LASEK (OR 2.09, 95% CrI 1.08-4.55), and Epi-LASIK (OR 2.74, 95% CrI 1.11-6.20). The SUCRA ranking (from best to worst) was FS-LASIK, T-PRK, LASEK, PRK, LASIK, Epi-LASIK. There were no statistically significant differences in the safety (best spectacle-corrected visual acuity) comparisons. For both postoperative higher-order aberrations (HOAs) and contrast sensitivity (CS), there were no statistically significant differences between any pair of treatments analyzed. The SUCRA ranking results show that some corneal surface ablation techniques (PRK and LASEK) rank highest.


CONCLUSIONS
This network meta-analysis shows that there were no statistically significant differences in either visual outcomes (efficacy and safety) or visual quality (HOAs and CS). FS-LASIK behaved better in predictability than any other type of surgeries.
School of Optometry and Ophthalmology and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China.
Daizong
D
Wen
School of Optometry and Ophthalmology and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China; University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom; ABM University Health Board, Swansea, United Kingdom; Flinders University, Adelaide, South Australia, Australia.
Colm
C
McAlinden
Department of Ophthalmology, Children's University Hospital, Dublin, Ireland.
Ian
I
Flitcroft
School of Optometry and Ophthalmology and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China.
Ruixue
R
Tu
School of Optometry and Ophthalmology and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China; Key Laboratory of Vision Science, Ministry of Health P.R. China, Wenzhou, Zhejiang, China.
Qinmei
Q
Wang
Vissum Corporación, Alicante, Spain; Division of Ophthalmology, Universidad Miguel Hernández, Alicante, Spain.
Jorge
J
Alió
Institute of Ophthalmology, University College London, London, United Kingdom.
John
J
Marshall
School of Optometry and Ophthalmology and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China.
Yingying
Y
Huang
School of Optometry and Ophthalmology and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China.
Benhao
B
Song
School of Optometry and Ophthalmology and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China; Key Laboratory of Vision Science, Ministry of Health P.R. China, Wenzhou, Zhejiang, China.
Liang
L
Hu
School of Optometry and Ophthalmology and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China; Key Laboratory of Vision Science, Ministry of Health P.R. China, Wenzhou, Zhejiang, China.
Yune
Y
Zhao
School of Optometry and Ophthalmology and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China.
Senmiao
S
Zhu
School of Optometry and Ophthalmology and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China; Key Laboratory of Vision Science, Ministry of Health P.R. China, Wenzhou, Zhejiang, China.
Rongrong
R
Gao
School of Optometry and Ophthalmology and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China; Key Laboratory of Vision Science, Ministry of Health P.R. China, Wenzhou, Zhejiang, China.
Fangjun
F
Bao
School of Optometry and Ophthalmology and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China; Key Laboratory of Vision Science, Ministry of Health P.R. China, Wenzhou, Zhejiang, China.
Ayong
A
Yu
School of Optometry and Ophthalmology and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China; Key Laboratory of Vision Science, Ministry of Health P.R. China, Wenzhou, Zhejiang, China.
Ye
Y
Yu
Department of Biological Statistics, Eye Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.
Hengli
H
Lian
School of Optometry and Ophthalmology and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China; Key Laboratory of Vision Science, Ministry of Health P.R. China, Wenzhou, Zhejiang, China. Electronic address: vip999vip@163.com.
Jinhai
J
Huang
D003315:Cornea / Q000601:surgery; D006801:Humans; D054018:Lasers, Excimer / Q000627:therapeutic use*; D009216:Myopia / Q000503:physiopathology / Q000601:surgery*; D018903:Photorefractive Keratectomy; D011184:Postoperative Period; D012029:Refraction, Ocular / Q000502:physiology*; D014792:Visual Acuity