Excimer laser treatment of spherical hyperopia: PRK or LASIK?

To compare the efficacy and safety of photorefractive keratectomy (PRK) and laser in situ keratomileusis (LASIK) in the treatment of spherical hyperopia with use of the VISX STAR S2 excimer laser.

A review of 15 consecutive patients (22 eyes) receiving PRK and 22 consecutive patients (26 eyes) receiving LASIK (median follow-up, 12 months).

Mean age was 52 +/- 7 years for patients receiving PRK and 55 +/- 9 years for patients receiving LASIK. Mean preoperative spherical equivalent was +2.25 +/- 1.16 D for PRK patients and +1.81 +/- 0.92 D for LASIK patients. Mean deviation from intended correction was -0.82 +/- 0.89 D after PRK and +0.19 +/- 0.47 D after LASIK at 1 month (P < .01); +0.16 D +/- 0.37 D after PRK and +0.29 +/- 0.51 D after LASIK at 6 months (P = .906); +0.20 +/- 0.35 D after PRK and +0.37 +/- 0.44 D after LASIK at 1 year (P = .301). At 1 year, 83.3% of PRK eyes and 61.5% of hyperopic LASIK eyes were within +/- 0.50 D of intended correction (P = 1.0). At 1 year, all eyes in both groups had acuity of 20/40 or better uncorrected, and 47.1% of PRK eyes and 54.5% of LASIK eyes had acuity of 20/20 or better uncorrected (P = 1.0). At last follow-up (minimum, 6 months), 2 eyes in each group had lost 2 lines of best spectacle-correct visual acuity, but none had lost more than 2 lines. All PRK patients experienced significant postoperative pain that required systemic medication. LASIK patients had only minor, transient discomfort.

LASIK and PRK are of comparable efficacy and safety. However, PRK was associated with significant post-operative pain, an initial and temporary myopic overshoot peaking at 1 month, and stability not occurring before 6 months. LASIK was less painful and was associated with more rapid stability (at 1 month) and a trend toward better uncorrected visual acuity, although not statistically significant.