Temporal Incidence of Dry Eye Disease, Visual Disturbances, and Ocular Pain After Laser-Assisted In Situ Keratomileusis Versus Photorefractive Keratectomy.

Abstract

To compare the incidence and timing of postoperative complications between laser-assisted in situ keratomileusis (LASIK) and photorefractive keratectomy (PRK) within a national clinical registry. Retrospective registry-based clinical cohort study. A total of 48,892 eyes of 27,372 patients who underwent refractive surgery in the IRIS Registry (Intelligent Research in Sight). LASIK and PRK procedures were identified using Healthcare Common Procedure Coding System codes. Postoperative complications, including dry eye disease (DED), visual disturbances, and ocular pain, were identified using International Classification of Diseases codes and analyzed at the eye level. Incidence was evaluated across three postoperative intervals (1 day to 1 month, 1 to 3 months, and 3 to 12 months). Interval-specific incidence rates and incidence rate ratios (IRRs) comparing LASIK and PRK were estimated using multivariable-adjusted Poisson generalized estimating equations. Interval-specific incidence of postoperative complications and comparative IRRs between LASIK and PRK. DED was the most frequently documented postoperative complication, occurring in 16.1% of LASIK eyes and 15.6% of PRK eyes over the follow-up period. During the 1 to 3 months interval, LASIK was associated with a lower incidence of DED compared with PRK (IRR, 0.8 [95% confidence interval (CI), 0.7-0.9]). In the first postoperative month, visual disturbances occurred more frequently after PRK (IRR, 0.3 [95% CI, 0.3-0.4]), but differences between procedures were not significant at later intervals. Ocular pain was rare after both procedures, with no consistent differences in early intervals, but showed a lower incidence after LASIK in the 3 to 12 months interval (IRR, 0.5 [95% CI, 0.3-0.9]). Postoperative complication profiles following refractive surgery varied by procedure and postoperative interval. PRK was associated with a higher risk of visual disturbances in the early postoperative period and a higher incidence of DED during the 1 to 3 months interval compared with LASIK. Ocular pain was rare overall but showed a lower incidence after LASIK in the 3 to 12 months interval, whereas most other complication rates were comparable between procedures. Recognition of these temporal patterns may help inform patient counseling, optimize postoperative follow-up strategies, and guide postoperative management during different phases of corneal recovery after refractive surgery.