Comparison of Outcomes after Custom-Q Laser in Situ Keratomileusis, Topography-guided Laser in Situ Keratomileusis, and Lenticule Extraction

Purpose: To compare the visual, refractive, and corneal optical outcomes of Custom-Q laser in situ keratomileusis (CQL), topography-guided laser in situ keratomileusis (TGL), and keratorefractive lenticule extraction (KLEx) in myopia and myopic astigmatism. Methods: In this retrospective cohort study, 212 eyes of 106 patients were analyzed 6 months after surgery (CQL, 62 eyes; TGL, 76 eyes; KLEx, 74 eyes). KLEx was performed with the CLEAR software on the FEMTO LDV Z8 platform. Visual, refractive, and astigmatic outcomes were compared. Corneal coma, trefoil, primary spherical aberration (SA), and total higher-order aberration (HOA) root mean square were analyzed at 2.0 to 7.0 mm, and the Q-value at 6.0 to 9.0 mm. Between-group differences in change were estimated with generalized estimating equations accounting for both eyes of each patient, with Bonferroni-adjusted pairwise comparisons; the 6.0-mm comparisons were designated primary. Results: Uncorrected distance visual acuity of 20/20 or better was achieved in 95.0% to 98.0% of eyes and the spherical equivalent was within ±1.00 diopter in 97.0%, with no between-group differences in visual, refractive, or astigmatic outcomes. Induced coma was lower after TGL than after both CQL and KLEx from 4.0 to 7.0 mm, and total HOA from 5.0 to 7.0 mm. At 6.0 and 7.0 mm, TGL and KLEx induced less SA and a smaller oblate shift in the Q-value than CQL. (all p < 0.05). Conclusions: Despite comparable visual and refractive outcomes, the three procedures produced distinct corneal optical profiles. TGL minimized coma and total HOA induction across most zones, whereas TGL and KLEx induced less peripheral SA and a smaller oblate shift than CQL. The largest differences arose at 6.0 and 7.0 mm, the former within the mesopic pupil of most patients; their effect on visual function was not assessed.