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Wavefront-guided versus non-wavefront-guided photorefractive keratectomy for myopia: meta-analysis of randomized controlled trials.

Kobashi H, Kamiya K, Hoshi K, Igarashi A, Shimizu K - PLoS ONE (2014)

Bottom Line: The pooled ORs and 95% confidence intervals (CIs) were computed for efficacy, safety, and predictability.In eyes with wavefront-guided PRK, the postoperative trefoil aberrations (mean difference -0.02; 95% CI, -0.03 to -0.00; p = 0.03) were significantly lower.According to the meta-analysis, wavefront-guided PRK offered no advantage in efficacy, predictability, or safety measures over non-wavefront-guided PRK, although it may have induced fewer trefoil aberrations.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, University of Kitasato School of Medicine, Kanagawa, Japan.

ABSTRACT

Purpose: To compare the efficacy, predictability, safety, and induced higher-order aberrations (HOAs) between wavefront-guided and non-wavefront-guided photorefractive keratectomy (PRK).

Methods: The Cochrane Central Register of Controlled Trials, PubMED, and EMBASE were searched for randomized controlled trials. Trials meeting the selection criteria were quality appraised, and data was extracted by 2 independent authors. Measures of association were pooled quantitatively using meta-analytical methods. Comparisons between wavefront-guided and non-wavefront-guided ablations were made as pooled odds ratios (ORs) or weighted mean differences. The pooled ORs and 95% confidence intervals (CIs) were computed for efficacy, safety, and predictability. The weighted mean differences and 95% CIs were used to compare induced HOAs.

Results: The study covered five trials involving 298 eyes. After wavefront-guided PRK, the pooled OR of achieving an uncorrected distance visual acuity of 20/20 (efficacy) was 1.18 (95% CI, 0.53-2.60; p = 0.69), the pooled OR of achieving a result within ±0.50 diopter of the intended target (predictability) was 0.86 (95% CI, 0.40-1.84; p = 0.70). No study reported a loss of 2 or more lines of Snellen acuity (safety) with either modality. In eyes with wavefront-guided PRK, the postoperative trefoil aberrations (mean difference -0.02; 95% CI, -0.03 to -0.00; p = 0.03) were significantly lower. There were no significant differences between the two groups in the postoperative total HOAs (mean difference -0.04; 95% CI, -0.23 to 0.14; p = 0.63), spherical (mean difference 0.00; 95% CI, -0.08 to 0.09; p = 0.93), and coma (mean difference -0.06; 95% CI, -0.14 to 0.03; p = 0.20) aberrations.

Conclusions: According to the meta-analysis, wavefront-guided PRK offered no advantage in efficacy, predictability, or safety measures over non-wavefront-guided PRK, although it may have induced fewer trefoil aberrations.

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Related in: MedlinePlus

Forest plot comparing HOAs outcomes after treatment with WFG-PRK and Non-WFG-PRK.A, Total HOAs. B, Spherical aberration. C, Coma aberration. D, Trefoil aberration. HOAs = higher-order aberrations, WFG-PRK =  wavefront guided photorefractive keratectomy, Non-WFG-PRK =  non-wavefront guided photorefractive keratectomy, IV = inverse variance, CI = confidence interval, Tau2 = tau-square statistic, Chi2 = chi-square statistic, df = degrees of freedom, I2 = I-square heterogeneity statistic, Z = Z-statistic.
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pone-0103605-g004: Forest plot comparing HOAs outcomes after treatment with WFG-PRK and Non-WFG-PRK.A, Total HOAs. B, Spherical aberration. C, Coma aberration. D, Trefoil aberration. HOAs = higher-order aberrations, WFG-PRK =  wavefront guided photorefractive keratectomy, Non-WFG-PRK =  non-wavefront guided photorefractive keratectomy, IV = inverse variance, CI = confidence interval, Tau2 = tau-square statistic, Chi2 = chi-square statistic, df = degrees of freedom, I2 = I-square heterogeneity statistic, Z = Z-statistic.

Mentions: Meta-analysis in relation to total HOAs, and to spherical, coma, and trefoil aberrations was conducted in 3 of the 5 studies. Of the 2 omitted studies, one [25] reported results on preoperative total HOAs, but the postoperative values for each group were not reported. One study [30] reported the HOA data in the figures, but the aberratios values for each group were not shown in the text. The total HOAs, spherical, and coma aberration Forest plots showed no significant differences in these values after treatment between wavefront-guided PRK and non-wavefront-guided PRK (Figure 4 A, B, and C). The trefoil aberration Forest plots showed that the increase in trefoil aberration in patients who had wavefront-guided PRK was less than that in those who had non-wavefront-guided PRK (weighted mean difference = −0.02; 95% CI, −0.03 to −0.00; p = 0.03) (Figure 4 D). Table 3 shows the clinical data in the 5 HOA studies.


Wavefront-guided versus non-wavefront-guided photorefractive keratectomy for myopia: meta-analysis of randomized controlled trials.

Kobashi H, Kamiya K, Hoshi K, Igarashi A, Shimizu K - PLoS ONE (2014)

Forest plot comparing HOAs outcomes after treatment with WFG-PRK and Non-WFG-PRK.A, Total HOAs. B, Spherical aberration. C, Coma aberration. D, Trefoil aberration. HOAs = higher-order aberrations, WFG-PRK =  wavefront guided photorefractive keratectomy, Non-WFG-PRK =  non-wavefront guided photorefractive keratectomy, IV = inverse variance, CI = confidence interval, Tau2 = tau-square statistic, Chi2 = chi-square statistic, df = degrees of freedom, I2 = I-square heterogeneity statistic, Z = Z-statistic.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4114780&req=5

pone-0103605-g004: Forest plot comparing HOAs outcomes after treatment with WFG-PRK and Non-WFG-PRK.A, Total HOAs. B, Spherical aberration. C, Coma aberration. D, Trefoil aberration. HOAs = higher-order aberrations, WFG-PRK =  wavefront guided photorefractive keratectomy, Non-WFG-PRK =  non-wavefront guided photorefractive keratectomy, IV = inverse variance, CI = confidence interval, Tau2 = tau-square statistic, Chi2 = chi-square statistic, df = degrees of freedom, I2 = I-square heterogeneity statistic, Z = Z-statistic.
Mentions: Meta-analysis in relation to total HOAs, and to spherical, coma, and trefoil aberrations was conducted in 3 of the 5 studies. Of the 2 omitted studies, one [25] reported results on preoperative total HOAs, but the postoperative values for each group were not reported. One study [30] reported the HOA data in the figures, but the aberratios values for each group were not shown in the text. The total HOAs, spherical, and coma aberration Forest plots showed no significant differences in these values after treatment between wavefront-guided PRK and non-wavefront-guided PRK (Figure 4 A, B, and C). The trefoil aberration Forest plots showed that the increase in trefoil aberration in patients who had wavefront-guided PRK was less than that in those who had non-wavefront-guided PRK (weighted mean difference = −0.02; 95% CI, −0.03 to −0.00; p = 0.03) (Figure 4 D). Table 3 shows the clinical data in the 5 HOA studies.

Bottom Line: The pooled ORs and 95% confidence intervals (CIs) were computed for efficacy, safety, and predictability.In eyes with wavefront-guided PRK, the postoperative trefoil aberrations (mean difference -0.02; 95% CI, -0.03 to -0.00; p = 0.03) were significantly lower.According to the meta-analysis, wavefront-guided PRK offered no advantage in efficacy, predictability, or safety measures over non-wavefront-guided PRK, although it may have induced fewer trefoil aberrations.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, University of Kitasato School of Medicine, Kanagawa, Japan.

ABSTRACT

Purpose: To compare the efficacy, predictability, safety, and induced higher-order aberrations (HOAs) between wavefront-guided and non-wavefront-guided photorefractive keratectomy (PRK).

Methods: The Cochrane Central Register of Controlled Trials, PubMED, and EMBASE were searched for randomized controlled trials. Trials meeting the selection criteria were quality appraised, and data was extracted by 2 independent authors. Measures of association were pooled quantitatively using meta-analytical methods. Comparisons between wavefront-guided and non-wavefront-guided ablations were made as pooled odds ratios (ORs) or weighted mean differences. The pooled ORs and 95% confidence intervals (CIs) were computed for efficacy, safety, and predictability. The weighted mean differences and 95% CIs were used to compare induced HOAs.

Results: The study covered five trials involving 298 eyes. After wavefront-guided PRK, the pooled OR of achieving an uncorrected distance visual acuity of 20/20 (efficacy) was 1.18 (95% CI, 0.53-2.60; p = 0.69), the pooled OR of achieving a result within ±0.50 diopter of the intended target (predictability) was 0.86 (95% CI, 0.40-1.84; p = 0.70). No study reported a loss of 2 or more lines of Snellen acuity (safety) with either modality. In eyes with wavefront-guided PRK, the postoperative trefoil aberrations (mean difference -0.02; 95% CI, -0.03 to -0.00; p = 0.03) were significantly lower. There were no significant differences between the two groups in the postoperative total HOAs (mean difference -0.04; 95% CI, -0.23 to 0.14; p = 0.63), spherical (mean difference 0.00; 95% CI, -0.08 to 0.09; p = 0.93), and coma (mean difference -0.06; 95% CI, -0.14 to 0.03; p = 0.20) aberrations.

Conclusions: According to the meta-analysis, wavefront-guided PRK offered no advantage in efficacy, predictability, or safety measures over non-wavefront-guided PRK, although it may have induced fewer trefoil aberrations.

Show MeSH
Related in: MedlinePlus