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Biomechanical Comparison of PRK, LASIK, and KLEx Using Personalized Finite Element Simulations.

Philippe Büchler1, Malavika H Nambiar1, Matteo Frigelli1

  • 1ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland.

Journal of Refractive Surgery (Thorofare, N.J. : 1995)
|October 9, 2025
PubMed
Summary

Photorefractive keratectomy (PRK) offers better outcomes than LASIK or KLEx by reducing undercorrection and improving stress distribution. PRK provides a greater biomechanical safety margin, especially for weaker corneas.

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Area of Science:

  • Ophthalmology
  • Biomechanical Engineering
  • Computational Modeling

Background:

  • Refractive surgery aims to correct vision by reshaping the cornea.
  • Photorefractive keratectomy (PRK), laser in situ keratomileusis (LASIK), and keratorefractive lenticule extraction (KLEx) are common refractive procedures.
  • Understanding the biomechanical effects of these surgeries is crucial for optimizing outcomes.

Purpose of the Study:

  • To investigate the biomechanical effects of PRK, LASIK, and KLEx on postoperative corneal biomechanics and visual outcomes.
  • To compare the refractive accuracy and stress distribution among the three procedures using patient-specific finite element simulations.

Main Methods:

  • Patient-specific finite element simulations were created for 30 patients undergoing PRK, LASIK, or KLEx.
  • Surgical models incorporated patient preoperative topographies and tailored ablation/lenticule profiles.
  • Mechanical model parameters were calibrated using experimental data from human corneal tissue.

Main Results:

  • All procedures showed undercorrection, increasing with higher spherical corrections; PRK had the least undercorrection.
  • Correction factors were determined: 1.40 for PRK, 1.57 for LASIK, and 1.71 for KLEx.
  • PRK maintained uniform anterior stress (28% increase), while LASIK (53%) and KLEx (44%) concentrated stress posteriorly.

Conclusions:

  • Corneal biomechanics significantly influence refractive surgery outcomes.
  • PRK demonstrates advantages in reduced undercorrection and more favorable stress distribution.
  • PRK's conservative approach offers a superior biomechanical safety margin, recommended for weaker corneas.