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Meta-analysis of Randomized Controlled Trials Comparing Excimer Laser and Phakic Intraocular Lenses for Myopia Between 6.0 and 20.0 Diopters

Barsam, Allon MA, FRCOphth; Allan, Bruce D. S. MD, FRCOphth

doi: 10.1097/ICO.0b013e31823f0b29
Review

Purpose: Meta-analysis of randomized controlled trials (RCTs) comparing excimer laser refractive surgery and phakic intraocular lenses (pIOLs) for the correction of myopia between 6.0 and 20.0 diopters (D). pIOLs are an alternative surgical option to excimer laser for these patients. The evidence base comparing these 2 methods has never been assessed systematically.

Methods: Cochrane Eyes and Vision Group, International. We performed a comprehensive literature search using the Cochrane Collaboration methodology to identify RCTs. A meta-analysis on the results of RCTs was performed. We analyzed data for efficacy outcomes, accuracy outcomes, safety outcomes, adverse effects, and quality-of-life measures.

Results: This review included 3 RCTs with a total of 228 eyes. The range of myopia was 6.0 to 20.0 D with up to 4.0 D of astigmatism. The pIOL group was less likely to lose 2 or more lines of best spectacle–corrected visual acuity at 12 months (odds ratio, 0.35; 95% confidence interval, 0.19–0.66, P = 0.001). PIOL surgery scored more highly on patient satisfaction/preference questionnaires.

Conclusions: The results of this systematic review show that pIOLs are safer within 1 year of follow-up compared with excimer laser surgical correction for myopia between 6 and 20 D. There is weaker evidence for superior visual quality in pIOL recipients. Further RCTs adequately powered for subgroup analysis with long-term follow-up are necessary to establish the ideal myopic range for excimer laser and pIOL treatments.

Department of External Disease, Moorfields Eye Hospital, London, United Kingdom.

Reprints: Allon Barsam, Department of External Disease, Moorfields Eye Hospital, London, United Kingdom (e-mail: abarsam@hotmail.com).

The authors have no financial or conflicts of interest to disclose.

Presented at the American Academy of Ophthalmology, Refractive Surgery Subspecialty Day, Chicago, October 2010.

Received March 19, 2011

Accepted October 14, 2011

© 2012 Lippincott Williams & Wilkins, Inc.