Preoperative Axial Length and Macular Thickness as Predictors of Myopic Regression Following Refractive Surgery

Abstract

Purpose: We investigated whether preoperative axial length (AL) and macular thickness (MT) are significant predictors of myopic regression following refractive surgery, including small incision lenticule extraction (SMILE), laser-assisted in situ keratomileusis (LASIK), and laser-assisted sub-epithelial keratectomy (LASEK).Methods: A retrospective cohort study was conducted on patients who underwent SMILE, LASIK, or LASEK and who were followed for 5 years postoperatively. Eyes with a myopic recurrence of -1.5 diopters (D) or greater were classified as the regressed group, whereas eyes with stable outcomes and no residual refractive error comprised the control group. Preoperative AL and MT were measured and compared between groups. Statistical analyses were performed using SPSS software.Results: In the SMILE group, the mean preoperative AL was significantly greater in the regressed group (26.63 mm) compared to the control group (25.83 mm; p < 0.01). Logistic regression identified AL as a significant predictor of myopic regression (odds ratio, 1.56), whereas MT was not statistically significant. The predictive performance of AL was highest in the SMILE group, with an area under the curve of 0.73, compared to LASIK and LASEK.Conclusions: Preoperative AL may serve as an important biometric predictor of myopic regression after refractive surgery, and appears particularly valuable for forecasting outcomes in patients undergoing SMILE.