One-Year Prospective Contralateral Eye Study: Visual Outcomes of Topography-guided LASIK Versus KLEx for Myopia and Myopic Astigmatism

Purpose: To compare 12-month visual outcomes, higher order aberrations (HOAs), epithelial remodeling patterns, and patient-reported outcomes (PROs) between topography-guided laser in situ keratomileusis (TG-LASIK) and keratorefractive lenticule extraction (KLEx). Methods: Forty patients (80 eyes) underwent TG-LASIK in one eye and KLEx in the fellow eye for myopia with and without astigmatism. Preoperative and up to 12-month evaluations included uncorrected distance visual acuity (UDVA), corrected distance visual acuity, contrast sensitivity, HOAs, corneal epithelial analysis, corneal hysteresis (CH), corneal resistance factor (CRF), and PROs. Results: At 1 year, all eyes achieved a UDVA of 20/20 or better. Spherical equivalent (SEQ) stability did not differ between groups. TG-LASIK showed better contrast sensitivity than KLEx at 1 month ( P < .001), which became comparable by 3 months. KLEx had more undercorrected cylinder than TG-LASIK at 12 months ( P = .033), with 97.5% of TG-LASIK and 85% of KLEx eyes achieving a residual cylinder of 0.50 diopters or less ( P = .02). KLEx induced higher vertical coma ( P < .001), whereas spherical aberration remained statistically unchanged in both groups. By 1 month, KLEx removed 2.5 ± 3.4 μm/diopter more stromal tissue ( P < .001); however, epithelial remodeling within the 2- and 5-mm zones compensated for this loss by 1 year. The decline in CH and CRF postoperatively was similar between platforms ( P > .05). At 12 months, there was no difference in subjective and objective dry eye symptoms between groups. Conclusions: KLEx resulted in greater vertical coma, stromal consumption per diopter, and undercorrected cylinder. Although early differences in PROs, eye preference, and contrast sensitivity transiently favored TG-LASIK, both procedures were comparable in terms of stability, predictability, CH, CRF, and patient satisfaction at 12 months.