Clinical outcomes of SMILE and WFG-LASIK used to treat myopia and astigmatism: A systematic review and meta-analysis

Purpose. - To evaluate the safety, efficacy and postoperative visual quality of small incision lenticule extraction (SMILE) and Wavefront-Guided Laser in situ keratomileusis (WFG-LASIK) and to analyze their efficacy in correcting astigmatism. Methods. - A systematic literature search was performed using Cochrane Collaboration methodology. Databases searched included PubMed, Embase, the Cochrane Library and Web of Science. RevMan software version 5.3.0 was used for meta -analysis. Results. - A total of 976 eyes were included in 8 studies, of which 539 eyes underwent SMILE and 437 eyes underwent WFG-LASIK. There were no statistically significant differences in the proportion of eyes achieving uncorrected distance visual acuity of 20/20 or better (P = 0.18), the proportion of eyes within +/- 0.50 diopter of target refraction postoperatively (P = 0.10), or the postoperative magnitude of cylinder (P = 0.10). Regarding the Alpins vector analysis of astigmatism, there was no statistically significant difference in the surgical magnitude of error (P = 0.09) between the two groups. WFG-LASIK has a lower surgical angle of error (P= 0.002) and higher surgical correction index of cylinder (P = 0.03) than SMILE. In terms of aberrations, higher order aberrations (P = 0.46), spherical aberrations (P = 0.22) and trefoil (P = 0.56) were not statistically different, while WFG-LASIK induc ed less coma than SMILE surgery (P = 0.02).Conclusion. - Both SMILE and WFG-LASIK are safe and effective ways to correct myopia and astigmatism. Compared with SMILE, WFG-LASIK has a lower surgical angle of error, higher surgical correction index of cylinder and induces less coma. (c) 2024 Elsevier Masson SAS. All rights reserved.