Corneal Epithelium Thickness and Refractive Changes After Myopic Laser Corneal Refractive Surgery.

PURPOSE: To evaluate the postoperative changes in corneal epithelium thickness and refractive power after femtosecond laser-assisted laser in situ keratomileusis (LASIK) and small incision lenticule extraction (SMILE) for myopia correction using anterior segment optical coherence tomography (OCT) with an integrated Placido disc topographer.

METHODS: The VisuMax 500-kHz femtosecond laser (Carl Zeiss Meditec AG) and Amaris 750 excimer laser (SCHWIND eye-tech-solutions) were used. Central, paracentral, and 6-mm epithelial thickness values were obtained, and the change in the value of epithelial thickness was calculated. Changes in the refractive power of the epithelium were also evaluated. The repeatability of this new measurement was also analyzed using the intraclass correlation (ICC). The total follow-up period was 6 months.

RESULTS: A total of 77 LASIK eyes were matched with 77 SMILE eyes. Mean spherical equivalent was -3.92 ± 1.67 diopters (D) for LASIK versus -4.02 ± 1.63 D for SMILE ( P = .356). Epithelial thickness parameters significantly and equally thickened in both types of surgery. The change in the value of epithelial thickness was positively correlated with spherical aberration. Analysis of the refractive power of the corneal epithelial layer (ICC > 0.70) showed a tendency for the postoperative myopization of the refractive component of this layer (-0.11 D for SMILE and -0.53 D for LASIK at 3 mm) and an increase in its cylinder and aberrometry. Increasing postoperative spherical aberration and epithelial thickness increased myopization of the epithelial refractive sphere ( P < .05).

CONCLUSIONS: Corneal epithelium thickens similarly after LASIK and SMILE, being slightly higher after SMILE. This correlates with the induced spherical aberration. Corneal epithelium thickening induces myopization of its refractive power, which accounts for a slight regression of the net refractive power change on the treated cornea. [ J Refract Surg . 2022;38(9):602-608.] .