Visual and refractive outcomes after keratorefractive lenticle extraction in moderate and high myopia: analysis of more than 1500 eyes

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Abstract
Purpose: To evaluate visual and refractive outcomes of keratorefractive lenticle extraction (KLEx) for the treatment of moderate and high myopia, defined by an attempted spherical equivalent (SEQ) correction between −6.0 diopters (D) and −8.0 D (moderate myopia) and from −8.0 to −10.0 D (high myopia), respectively. Setting: Cornea and Refractive Surgery Unit, Department of Ophthalmology, Aarhus University Hospital, Aarhus, Denmark. Design: Prospective longitudinal quality control study. Methods: Prospective analysis of 1530 right eyes consecutively treated with KLEx for myopia correction between January 2011 and December 2023. Exclusion criteria included SEQ less than −6.0 D, refractive astigmatism larger than 2.0 D, or presence of other ocular diseases. Preoperative and 3-month evaluation included manifest refraction and uncorrected distance visual acuity (UDVA) and corrected distance visual acuity. Results: Attempted SEQ refraction was −7.03 ± 0.50 D and −8.71 ± 0.56 D in the moderate and high myopia groups, respectively. 62% (n = 586) and 52% (n = 239) of moderate and high myopia eyes achieved postoperative UDVA ≥20/20, P < .001, respectively. Efficacy index was 0.86 ± 0.26 and 0.83 ± 0.28 ( P = .044) for moderate and high myopia, respectively. 81% (n = 825) and 71% (n = 360) of moderate and high myopes were within ±0.50 D of intended refraction, P < .001, respectively. Safety index was 1.07 ± 0.20 and 1.09 ± 0.19 for moderate and high myopia ( P = .056), respectively. Conclusions: The safety of KLEx for moderate and high myopia was similar in this large cohort. Predictability and efficacy were slightly better when treating moderate myopia and lower astigmatism. Nomogram adjustment for the correction of high myopia is suggested.

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