Surgical Outcomes of Photorefractive Keratectomy, Femtosecond-LASIK, and SMILE for Myopia and Myopic Astigmatism: A Comparative Study in Babylon, Iraq

Purpose:  To compare the surgical outcomes of Photorefractive Keratectomy (PRK), Femtosecond-LASIK (FSL), and Small Incision Lenticule Extraction (SMILE) in patients with myopia and myopic astigmatism. Study Design:  Retrospective chart analysis. Place and Duration of Study:  This study was conducted with a retrospective cohort design in myopia and myopic astigmatism patients from two clinics in Babylon, Iraq between February 2021 and March 2023. Method:  Retrospective analysis of patients with myopia and myopic astigmatism who underwent kerato-refractive surgery were evaluated for pre-operative and post-operative refraction, corneal topography, and contrast sensitivity. Standardized laser protocols were used for surgery, with follow-ups at 30 days, 90 days, and 6 months. Results:  This study included 217 eyes from 109 patients who had PRK, SMILE, and FSL. The patients in FS-LASIK group were older than other groups (p = 0.013), while gendershowed insignificant difference among the three methods (P = 0.480). No statistically significant differences were observed in preoperative visual acuity (P = 0.083), sphere (P = 0.206), cylinder (P = 0.278), or spherical equivalent (P = 0.232) among the groups. After the surgery, all three groups showed significant improvements in best corrected visual acuity, spherical error, cylindrical error, and spherical equivalent (P < 0.001). Keratometry values and central corneal thickness significantly decreased in all groups (P < 0.001) after the surgery. Contrast sensitivitydeclinedone month after the surgery but improved significantly by 6 months (P < 0.001). Conclusion:  PRK, Femto-LASIK, and SMILE are all effective in managing myopia and myopic astigmatism, with significant improvements in visual acuity, refractive errors, and keratometry values across all groups. Keywords:  Refractive Surgery, Photorefractive Keratectomy, Femtosecond LASIK, Small Incision Lenticule Extraction, Visual Acuity.