Wavefront-guided epithelial laser in situ keratomileusis with mitomycin-C for myopia and myopic astigmatism: Flap-on versus flap-off technique

PURPOSE: To compare the postoperative pain, visual recovery, and outcomes of flap-on and flap-off epithelial laser in situ keratomileusis (epi-LASIK) with mitomycin-C (MMC). SETTING: Asian Eye Institute, Makati, Philippines. DESIGN: Case-control study. METHODS: Patients with myopia up to 9.00 diopters had wavefront-guided epi-LASIK with MMC. After randomization, the epithelium was removed in 1 eye (flap off) and repositioned in the other eye (flap on). Questionnaires were used to evaluate postoperative pain and visual recovery in each eye during the first postoperative week. Visual results, refractive outcomes, contrast sensitivity, and higher-order aberrations (HOAs) were compared and analyzed. RESULTS: The study evaluated 48 eyes. The mean pain scores were lower and better vision was perceived in the flap-off group during the first postoperative week. One year postoperatively, the mean uncorrected distance visual acuity was -0.088 logMAR in the flap-on group and -0.036 logMAR in the flap-off group (P=.918). The spherical equivalent was within +/- 0.50 D in 92% of eyes in both groups (P>.05). Forty-six percent in the flap-on group and 38% in the flap-off group gained 1 line of corrected distance visual acuity (P=.915). Contrast sensitivity tests under daytime and nighttime conditions were comparable. There was no statistically significant difference in the mean change in HOAs between groups. CONCLUSIONS: Wavefront-guided epi-LASIK with MMC was effective, safe, and predictable in treating myopia and myopic astigmatism. Eyes that had flap-off epi-LASIK had less pain and faster visual recovery. Visual results, refractive outcomes, contrast sensitivity, and HOAs were comparable between groups.