| Purpose To systematically evaluate the influence of higher order aberrations between Laser in-Situ Keratomileusis(LASIK)and Laser Epithelial Keratomileusis(LASEK).Methods According to the way of Cochrane systematic review,we searched databases such as Pubmed,Cochrane Library,EMBASE,CBM,CNKI,WanFang Data and VIP to collect relevant clinical controlled researches about the influence of LASIK versus LASEK on higher order aberrations.The retrieval time was from inception to May 2016,and the language was Chinese or English.Data extraction and literature quality assessment were conducted by two researchers independently and the final meta-analysis was performed by RevMan 5.3 software to compare the change value of total higher aberration,coma,sphere aberration,vertical coma,horizontal coma,trefoil,fifth and sixth order aberration RMS(root mean square).Results The meta-analysis included 10 non-randomized controlled trials(non-RCT)involving 593 patients in all,among which the LASIK group had 286 cases and the LASEK group had 307 cases.Methodological Index for Non-Randomized Studies(MINORS)form was used as the criterion of quality assessment.The main analytic results were showed as below.1.There was no statistical difference on the influence of the change value of total higher order aberration RMS between LASIK and LASEK in postoperative 1 month,3 months and 6 months(1 month:SMD=0.03,95%CI=[-0.50,0.56],p=0.91;3 months:SMD=0.11;95%CI=[-0.39,0.61],p=0.66;6 months: SMD=0.20,95%CI=[-0.05,0.45],p=0.12).2.The influences of the change value of coma RMS between LASIK and LASEK in postoperative 1 month,3 months and 6 months(1 month:SMD=-0.29,95%CI=[-1.07,0.48],p=0.46;3 months:SMD=0.18,95%CI=[-0.49,0.86],p=0.59;6 months:SMD=0.33,95%CI=[-0.18,0.83],p=0.20)were without statistical difference.3.The statistical differences were found in postoperative 6 months and LASEK had greater influence on sphere aberration than LASIK(6 months:SMD=0.17,95%CI=[0.00,0.33],p=0.04),although less difference was showed in postoperative 1 month,3 months(1 month:SMD=-0.02,95%CI=[-0.47,0.42],p=0.92;3months:SMD=0.12,95%CI=[-0.50,0.75],p=0.70)on the influence of the change value of total sphere aberration RMS between LASIK and LASEK.4.It were showed statistical differences on the influence of the change value of vertical coma RMS between LASIK and LASEK in postoperative 1 month,and LASIK had greater influence than LASEK(1 month:SMD=-0.35,95%CI=[-0.57,-0.13],p=0.002),with few statistical difference in postoperative 3 months and 6 months(3 months:SMD=0.14,95%CI=[-0.65,0.92],p=0.73;6 months:SMD=0.32,95%CI=[-0.27,0.91],p=0.29).5.There were not statistical differences on the influence of the change value of horizontal coma RMS between LASIK and LASEK in postoperative 1 month,3 months and 6 months(1 month:SMD=-0.14,95%CI=[-0.36,0.08],p=0.20,3 months:SMD=0.02,95%CI=[-0.39,0.42],p=0.94;6 months:SMD=0.03,95%CI=[-0.17,0.23],p=0.79).6.There were no statistical differences on the influence of the change value of trefoil RMS between LASIK and LASEK in postoperative 1 month and 6 months(1 month:SMD=0.09,95%CI=[-0.47,0.64],p=0.76;6 months:SMD=0.28,95%CI=[-0.45,1.01],p=0.45).7.The statistical differences were displayed on the influence of the change value of fifth order aberration RMS between LASIK and LASEK in postoperative 1 month,and LASEK had greater influence than LASIK(1 month:SMD=0.43,95%CI=[0.17,0.69],p=0.001),without statistical difference in postoperative 3 month(3 months:SMD=0.57,95%CI=[-0.10,1.24],p=0.10).8.The significant differences were also found on the influence of the change value of sixth order aberration RMS between LASIK and LASEK in postoperative 1 month and 3 months,and LASEK had greater influence than LASIK(1 month:SMD=0.52,95%CI=[0.26,0.78],p<0.0001;3 months:SMD=0.52,95%CI=[0.26,0.78],p<0.0001).9.The error line graphs of each higher order aberration RMS change value's SMD and 95%CI showed that,with the follow-up time extending,LASEK group appeared a increasing tend on the influence of the change value of each higher order aberration RMS.Conclusions On the whole,the influence on higher order aberrations between LASIK and LASEK,within postoperative 6 months,has no significant difference.However,the influence on higher order aberrations of LASEK has a increasing tend with the follow-up time extended,and LASEK shows a greater influence on sphere aberration than LASIK in postoperative 6 month. |
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