Comparative outcomes and predictability of Contoura laser-assisted in situ keratomileusis, wavefront-optimized laser-assisted in situ keratomileusis, and photorefractive keratectomy: A retrospective analysis of visual recovery and pachymetric influence

Purpose: The purpose of this study was to compare visual and refractive outcomes of Contoura topography-guided laser-assisted in situ keratomileusis (LASIK), wavefront-optimized (WFO) LASIK, and photorefractive keratectomy (PRK) and to evaluate the influence of preoperative pachymetry on residual refractive error and recovery. Methods: This retrospective cohort study included 180 eyes from 110 patients who underwent Contoura LASIK ( n = 60), WFO LASIK ( n = 70), or PRK ( n = 50) at a tertiary center in Northern India between December 2024 and June 2025. Key parameters analyzed included manifest refraction, uncorrected visual acuity (UCVA), spherical equivalent (SE), dry eye incidence, and minor complications. Correlation analysis was performed between central corneal thickness and residual SE at 6 months. Results: All procedures led to significant SE improvement ( P < 0.001). Predictability within ±0.50 D was highest in Contoura LASIK (97%), followed by WFO LASIK (95%) and PRK (90%) ( P = 0.04). UCVA ≥20/25 was achieved at 1 month in 82% (Contoura), 75% (WFO LASIK), and 48% (PRK), converging by 3 months. Dry eye symptoms peaked in WFO LASIK (18%) and resolved by month three in all groups. A weak inverse correlation was noted between pachymetry and residual SE ( r = −0.22, P = 0.03). No major complications occurred. Conclusion: Contoura LASIK showed superior refractive precision and earlier visual recovery. PRK remained a safe alternative in thinner corneas. Preoperative pachymetry modestly influenced refractive predictability. All three modalities proved safe and effective, supporting procedure selection based on individualized patient profiles.