Femtosecond laser-assisted sub-Bowman keratomileusis versus laser-assisted subepithelial keratomileusis to correct myopic astigmatism

PURPOSE: To compare femtosecond laser-assisted sub-Bowman keratomileusis (FSBK) versus laser-assisted subepithelial keratomileusis (LASEK) to correct moderate to high myopic astigmatism. METHODS: Retrospective, nonrandomized, interventional, comparative case series. A total of eight hundred and fifty-two eyes with myopic astigmatism of −1.5 diopters (D) or higher were included in the study. We compared 427 eyes treated with FSBK versus 425 eyes treated with LASEK with or without mitomycin C. Visual and refractive results were evaluated 1 day, 1 week, 3 and 6 months postoperatively. RESULTS: Six months postoperatively, the residual spherical defect was slightly but significantly higher in the LASEK group (+0.15 ± 0.62 D) than in the FSBK group (+0.09 ± 0.35 D) (P = 0.05). The postoperative residual astigmatism was also slightly but significantly higher in the LASEK group (−0.38 ± 0.52 D) than in the FSBK group (−0.26 ± 0.45 D) (P = 0.0005). No significant differences were found in the efficacy (0.98 ± 0.17 versus 0.98 ± 0.36, P = 0.6) and safety indexes (1.04 ± 0.16 versus 1.05 ± 0.37, P = 0.1) between FSBK and LASEK. The enhancement rate was significantly higher in the FSBK group (22.6%) than in the LASEK group (15.5%) (P = 0.01). CONCLUSIONS: Both FSBK and LASEK are safe and effective procedures to correct moderate to high myopic astigmatism. Slightly better visual and refractive results were observed in FSBK-treated eyes in a 6-month follow-up.