Evaluations Of Visual Quality After LASIK And Phakic Intraocular Lens Implantation For Correction Of High Myopia

ObjectiveTo assess the visual quality after wavefont-guided femtosecond laser assisted LASIK, Cachet angle-supported phakic intraocular lens(PIOL) implantation and ICL posterior chamber phakic intraocular lens implantation for high myopia. MethodsIn this retrospective clinical study,30patients (58eyes) were performed LASIK, while22patients (41eyes) and22patients (42eyes) were implanted with Cachet PIOL and ICL PIOL respectively from January2010to February2012in Tianjin Medical University Eye Hospital. The follow-up time was one year. Uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), near visual acuity, refraction, higher-order aberrations, contrast sensitivity, visual symptoms and patient satisfaction after surgery were analyzed primarily during1-year of follow-up.Results1. During1year follow-up, postoperative UCVA increased significantly than preoperative(P<0.001), and kept stable, with no statistically significant difference in three groups(P=0.42,0.68,0.08). The efficacy index of three groups were more than1.0, and they were1.09,1.09,1.14at1year postoperatively, respectively.2. In three groups, postoperative BSCVA increased significantly than preoperative(P <0.01), and kept stable during1year follow-up(P=0.30,0.07,0.20). The safety index of three groups were more than1.0, and they were1.15,1.23,1.32at1year postoperatively, respectively.3. Postoperatively, there was no statistically significant differences in near visual acuity(P>0.05), but the reading distance under uncorrected condition was improved significantly in three groups,.4. The postoperative mean spherical equivalent refraction decreased significantly in three groups(P<0.001). In LASIK group, there was no statistically significant difference in SE between1month and3months,6months and1year postoperatively(P=0.753,0.116), while SE at6months increased significantly than3months postoperatively towards myopia(P<0.001). And postoperative SE remained stable at subsequent follow-ups in both Cachet and ICL groups(P=0.661,0.290).5. At1year postoperatively, spherical and coma aberrations increased significantly (P<0.05) in LASIK group, while higher-order aberrations did not have significant change in Cachet group and ICL group(P>0.05).6. In LASIK group, contrast sensitivity decreased at1month, but then went back to the preoperative level at6months and1year. In Cachet group, no significant difference was found in contrast sensitivity at1month, but contrast sensitivity at3.0c.d-1and6.0c.d-1spatial frequencies under photopic condition increased significantly at3months(P=0.048,0.005;0.041,0.030), and contrast sensitivity was elevated significantly at1.5c.d-,3.0c.d-1,6.0c.d-1spatial frequencies from6months to1year under photopic and mesopic conditions (P<0.05). In ICL group, there was no significant difference in contrast sensitivity at1month, but contrast sensitivity at1.5c.d-1,3.0c.d-1,6.0c.d-1and12.0c.d-1spatial frequencies under photopic with/without glare conditions and at1.5c.d-1,3.0c.d-1and6.0c.d-1spatial frequencies under mesopic without glare conditions increased significantly at3months (P<0.05), and contrast sensitivity increased significantly at1.5c.d-1,3.0c.d-1,6.0c.d-1and12.0c.d-1spatial frequencies from6months to1year under photopic and mesopic conditions (P<0.05).7. At1month postoperatively, the percentage of glare, halos and starbursts happened in LASIK group patients was15.5%,20.7%and10.3%, respectively, and10.0%of patients had difficulties in night driving. In Cachet group, the percentage of glare and halos was7.3%and12.2%, which played no role in people’s normal life. In ICL group, glare and halos existed in9.5%and28.6%of eyes, which also had no influence on people’s normal life. At1year, all visual symptoms disappeared, and a good patient satisfaction was received.Conclusions1. Wavefront-guided femtosecond laser assisted LASIK, Cachet PIOL implantation and ICL implantation were all improved effective in correction of refractive error, but PIOL implantations did better than LASIK in refraction stability for correction of high myopia. They all did not change the near visual acuity, but could improve the reading distance significantly under uncorrected condition.2. The Cachet PIOL implantation and ICL implantation showed better outcomes at aberrations than LASIK, for that Cachet and ICL implantations did not change higher-order aberrations postoperatively, but LASIK did.3. In LASIK group, contrast sensitivity decreased at postoperative early stage, but then went back to the preoperative level gradually, while contrast sensitivity increased in Cachet and ICL groups, of which the amplitude was similar.4. Patients in LASIK group had more and severe visual symptoms than that in Cachet and ICL groups, which lasted for a longer time. Some of the patients complained of night driving difficulty because of the visual symptoms. And patient satisfaction about surgeries in all groups were good at1year.