[Comparison of visual outcomes between corneal topography-guided FS-LASIK and SMILE for myopia and myopic astigmatism: a network meta-analysis]

Abstract

Objective: To compare the postoperative visual outcomes of corneal topography-guided femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK) and small incision lenticule extraction (SMILE) for myopia and myopic astigmatism. Methods: Embase and PubMed were searched for randomized controlled trials (RCTs), prospective comparative studies, observational studies and retrospective studies of patients with myopia and/or myopic astigmatism treated by corneal topography-guided FS-LASIK, the other FS-LASIKs or SMILE (inception to November 2023). The studies meeting the criteria were collected and underwent quality assessment according to the Jadad scale for RCTs and the Newcastle-Ottawa scale for non-randomized studies. RevMan4.3.0 was used for network meta-analysis. Results: A total of 17 studies were included for meta-analysis, including 7 RCT and 10 observational studies. For the percentage of surgical eyes with uncorrected distance visual acuity≥20/20 (≤3 months), there were no statistically significant differences among corneal topography-guided FS-LASIK, the other FS-LASIKs and SMILE. The surface under the cumulative ranking curve (SUCRA) ranking from best to worst was corneal topography-guided FS-LASIK (86.7%), the other FS-LASIKs (53.1%) and SMILE (10.2%). For the percentage of surgical eyes with postoperative manifest refraction spherical equivalent (MRSE) within ±0.50 D (combined follow-up measure timepoint), the main analyses showed no statistical differences among the 3 surgery groups. The sensitivity analyses disclosed the relative risk (RR) of corneal topography-guided FS-LASIK significantly increased by 14% (RR=1.14, 95%CI:0.78-1.59) as compared to that of the other FS-LASIKs, while there was no significant difference between SMILE and the other FS-LASIKs. The SUCRA ranking from best to worst was corneal topography-guided FS-LASIK (90.4%), SMILE (31.7%) and the other FS-LASIKs (27.9%). For the percentage of surgical eyes with postoperative MRSE within± 1.00 D (combined follow-up measure timepoint), the main analyses showed no statistical differences among the 3 surgery groups. The sensitivity analyses showed the RR of corneal topography-guided FS-LASIK significantly increased by 15% (RR=1.15, 95%CI:0.93-1.61) as compared to that of the other FS-LASIKs, while there was no significant difference between SMILE and the other FS-LASIKs. The SUCRA ranking from best to worst was corneal topography-guided FS-LASIK (94.5%), the other FS-LASIKs (53.9%) and SMILE (1.7%). For the percentage of surgical eyes with postoperative corrected distance visual acuity improved by 1 or more lines (combined follow-up measure timepoint), the main analyses showed no statistical difference between corneal topography-guided FS-LASIK and the other FS-LASIKs, while the RR of SMILE was slightly lower than that of the other FS-LASIKs (RR=0.86, 95%CI:0.65-1.14). The sensitivity analyses disclosed the RR of corneal topography-guided FS-LASIK significantly increased by 40% (RR=1.40, 95%CI:0.06-24.00) as compared to that of the other FS-LASIKs, while SMILE had a slightly lower RR as compared with the other FS-LASIKs (RR=0.77, 95%CI:0.17-2.74). The SUCRA ranking from best to worst was corneal topography-guided FS-LASIK (72.4%), the other FS-LASIKs (67.3%) and SMILE (10.3%). Conclusions: Compared with SMILE, FS-LASIK showed a similar postoperative visual acuity improvement. The corneal topography-guided FS-LASIK had better predictability with a higher rate of MRSE within ±0.50 D/1.00 D.