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Post-operative efficacy, predictability, safety and visual quality of laser corneal refractive surgery: a network meta-analysis

Wen, D; McAlinden, C; Flitcroft, I; Tu, R; Wang, Q; Alió, J; Marshall, J; ... Huang, J; + view all (2017) Post-operative efficacy, predictability, safety and visual quality of laser corneal refractive surgery: a network meta-analysis. American Journal of Ophthalmology , 178 pp. 65-78. 10.1016/j.ajo.2017.03.013. Green open access

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Abstract

PURPOSE: To compare the post-operative efficacy, predictability, safety and visual quality of all major forms of laser corneal refractive surgeries for correcting myopia. DESIGN: Systematic review and network meta-analysis. METHODS: 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: 48 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: FS-LASIK, LASIK, SMILE, FLEx, PRK, LASEK, Epi-LASIK, T-PRK. For predictability (refractive spherical equivalent (SE)), a statistical significant difference was found when FS-LASIK was compared with LASIK (OR 2.29, 95% 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 (BSCVA)) comparisons. For both post-operative 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 both visual outcomes (efficacy and safety) and visual quality (HOAs and CS). FS-LASIK behaved better in predictability than any other types of surgeries.

Type: Article
Title: Post-operative efficacy, predictability, safety and visual quality of laser corneal refractive surgery: a network meta-analysis
Location: United States
Open access status: An open access version is available from UCL Discovery
DOI: 10.1016/j.ajo.2017.03.013
Publisher version: http://doi.org/10.1016/j.ajo.2017.03.013
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
UCL classification: UCL
UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > Institute of Ophthalmology
URI: https://discovery.ucl.ac.uk/id/eprint/1549768
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