Zyoptix wavefront-guided versus standard photorefractive keratectomy (PRK) in low and moderate myopia: randomized controlled 6-month study.

PURPOSE To evaluate the refractive and aberrometric outcome of wavefront-guided photorefractive keratectomy (PRK) compared to standard PRK in myopic patients. METHODS Fifty-six eyes of 56 patients were included in the study and were randomly divided into two groups. The study group consisted of 28 eyes with a mean spherical equivalent (SE) of -2.25+/-0.76 diopters (D) (range: -1.5 to -3.5 D) treated with wavefront-guided PRK using the Zywave ablation profile and the Bausch & Lomb Technolas 217z excimer laser (Zyoptix system) and the control group included 28 eyes with a SE of -2.35+/-1.01 D (range: -1.5 to -3.5 D) treated with standard PRK (PlanoScan ablation) using the same laser. A Zywave aberrometer was used to analyze and calculate the root-mean-square (RMS) of total high order aberrations (HOA) and Zernike coefficients of third and fourth order before and after (over a 6-month follow-up period) surgery in both groups. Preoperative and postoperative SE, un-corrected visual acuity (UCVA), and best-corrected visual acuity (BCVA) were evaluated in all cases. RESULTS There was a high correlation between achieved and intended correction. The differences between the two treatment groups were not statistically significant for UCVA, BCVA, or SE cycloplegic refraction . Postoperatively the RMS value of high order aberrations was raised in both groups. At 6-month control, on average it increased by a factor of 1.17 in the Zyoptix PRK group and 1.54 in the PlanoScan PRK group (p=0.22). In the Zyoptix group there was a decrease of coma aberration, while in the PlanoScan group this third order aberration increased. The difference between postoperative and preoperative values between the two groups was statistically significant for coma aberration (p=0.013). No statistically significant difference was observed for spherical-like aberration between the two groups. In the study group eyes with a low amount of preoperative aberrations (HOA RMS lower than the median value; <0.28 microm) showed an increase of HOA RMS while eyes with RMS higher than 0.28 microm showed a decrease (p<0.05). CONCLUSIONS Zyoptix wavefront-guided PRK is as safe and efficacious for the correction of myopia and myopic astigmatism as PlanoScan PRK. Moreover this technique induces a smaller increase of third order coma aberration compared to standard PRK. The use of Zyoptix wavefront-guided PRK is particularly indicated in eyes with higher preoperative RMS values.