Outcomes of Keratorefractive Lenticule Extraction in Older Adults: A Multicenter Analysis.

PURPOSE: To assess the safety, efficacy, and refractive outcomes of keratorefractive lenticule extraction (KLEx) in adults aged 55 years or older compared to patients 35 years or younger, addressing the limited evidence for KLEx in presbyopic eyes. METHODS: This retrospective multicenter study included patients aged 55 years or older and a control group aged 35 years or younger matched by preoperative mean refractive spherical equivalent (MRSE), all undergoing KLEx for myopia or myopic astigmatism. Preoperative parameters and postoperative refractive and visual outcomes were analyzed. RESULTS: A total of 288 eyes of 183 patients were analyzed (144 were 55 years or older, 144 were 35 years or younger), with comparable baseline parameters between groups. Postoperative UDVA was slightly inferior in older adults (mean: -0.01 vs -0.07 logarithm of the minimum angle of resolution; 20/20 or better in 79% vs 93%, P < .001). The efficacy index was 0.94 versus 1.07 and the safety index was 1.01 versus 1.09 (both P < .001) for patients 55 years or older and 35 years or younger, respectively. Eleven percent of older patients and 39% of younger patients gained lines. A postoperative MRSE within ±0.50 diopters (D) was achieved by 76% of older versus 88% of younger patients (P = .02) and more than 95% were within ±1.00 D in both groups. Re-treatments were more frequent in older eyes (9% vs 1%, P = .01). Stability and astigmatic outcomes were comparable, although older eyes showed mild cylindrical overcorrection. CONCLUSIONS: KLEx in patients aged 55 years or older provided favorable and stable outcomes but was inferior when compared to younger cohorts regarding efficacy, safety, and predictability. These findings point to clinically meaningful age-related corneal biomechanical changes and carry implications for both surgical planning and patient counseling.