Wavefront-guided versus cross-cylinder photorefractive keratectomy in moderate-to-high astigmatism: a cohort of two consecutive clinical trials

BACKGROUND: Although there have been many studies of the efficacy and safety of wavefront- guided (WF) and cross-cylinder photorefractive keratectomy (PRK), there are few studies on moderate-to-high astigmatism cases. The aim of this study was to assess and compare the efficacy of WF and cross-cylinder PRK in moderate-to-high astigmatism. METHODS: In a comparative cohort, the results of two before-and-after clinical trials conducted on moderate-to-high astigmatism were studied. In the first trial, 50 eyes of 25 patients with stable refraction were enrolled in a before-and-after clinical trial to undergo WF PRK using the VISX™ (VISX Inc, Santa Clara, CA) system. The second clinical trial enrolled 48 eyes of 24 patients with stable refraction and moderate-to-high astigmatism to undergo PRK by the cross-cylinder method using a NIDEK EC-5000 excimer laser system (NIDEK Co Ltd, Gamagori, Japan). RESULTS: After 6 months, 80% of the eyes in the WF group had uncorrected visual acuity of 20/20 or better compared to 40% in the cross-cylinder group. Only one eye in the cross-cylinder group and no eyes in the WF group lost more than one line of best corrected visual acuity (BCVA) after 6 months of treatment. No treated eyes in either group lost more than two lines of BCVA. The percentage of eyes with no change in BCVA was 54% and 58.3% in the WF and cross-cylinder groups, respectively. Mean postoperative absolute changes in total root-mean-square higher order aberrations in the WF group and cross-cylinder group were 0.05 ± 0.22 μm and 0.17 ± 0.20 μm, respectively (P < 0.001). CONCLUSION: Both methods of PRK, using the NIDEK EC-5000 and VISX excimer laser systems, are effective for correcting moderate-to-high astigmatism. The WF approach appeared more successful in improving the refractive results.