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The aim of this study is to compare the refractive parameters and visual quality of patients with low to moderate myopia and high myopia before and after transepithelial photorefractive keratectomy(transPRK)to evaluate the efficacy and safety of transPRK in correcting different degrees of myopia, and to explore the impact of the surgery on the visual quality of patients with different spherical equivalent(SER). This study retrospectively included myopic patients who underwent transPRK using the Schwind Amaris excimer laser. The patients were divided into the low to moderate and high myopia groups according to the preoperative spherical equivalent. The subjects’ refractive parameters and visual quality before, at 1, 3, and 6 months after surgery were collected and analysed. The changes in each value before and after surgery (Δ) were compared. At 6 months after surgery, 96.8% (low to moderate myopia group) and 92.3% (high myopia group) of the eyes in both groups achieved uncorrected distance visual acuity (UDVA) of 20/20 or above. At 6 months after surgery, 65.1% of the eyes in the low to moderate myopia group had SER within ± 0.5D, and 95.2% had SER within ± 1.0D. In the high myopia group, 71.8% of the eyes had SER within ± 0.5D, and 97.4% had SER within ± 1.0D. No patient lost one or more lines of corrected distance visual acuity (CDVA) simultaneously after surgery. All patients achieved a CDVA of 20/20 after surgery. There were significant differences in △corneal higher-order aberrations at 6.0 mm pupil(C.HOA), △corneal spherical aberration at 6.0 mm pupil(C.Sph), and △corneal coma aberration at 6.0 mm pupil(C.Coma) between the two groups ( P  < 0.05). In comparison, there were no significant differences in △corneal trefoil aberration at 6.0 mm pupil(C.Tre), △and the strehl ratio(SR) between the two groups ( P  > 0.05). There were significant differences in △central corneal thickness (CCT), △anterior surface asphericity of the cornea (Q), △eccentricity (e) and △corneal curvature (K1, K2, and Km) between the two groups ( P  < 0.001). In the low to moderate myopia group, △SER was positively correlated with △C.HOA and △C.Sph ( P  < 0.01), and △SER was positively correlated with △C.Coma at 6 months ( P  < 0.01); there was no correlation between △SER and △C.Tre and △SR ( P  > 0.05). In the high myopia group, △SER was positively correlated with △C.HOA at 6 months ( P  < 0.05); △SER was positively correlated with △C.Sph and △SR at 3 and 6 months ( P  < 0.05). There was no correlation between △SER and △C.Coma or △C.Tre ( P  > 0.05). This study demonstrates that transPRK can safely and effectively correct the UDVA and refractive status of patients with low to moderate and high myopia. Compared with patients with low to moderate myopia, patients with high myopia have more increases in C.HOA, C.Sph, and C.Coma at the same time point after surgery.△SER is positively correlated with △C.HOA after surgery. Among the three aberrations, the correlation between △SER and △C.Sph is the strongest in the high myopia group simultaneously.

The type and nature of refractive surgery procedures has greatly increased over the past few decades, allowing for almost all patient populations to be treated to extremely high satisfaction. Conventional photorefractive keratectomy involves the removal of the corneal epithelium through mechanical debridement or dilute alcohol instillation. An improvement to this method utilises laser epithelial removal in a single-step process termed transepithelial photorefractive keratectomy (transPRK). We explore the history of transPRK from its early adoption as a two-step process, identify different transPRK platforms from major manufacturers, and describe the role of transPRK in the refractive surgery armamentarium. This is a narrative review of the literature. This review finds that TransPRK is a safe and effective procedure that works across a variety of patient populations. Though often not seen as a primary treatment option when compared to other corneal-based procedures that offer a faster and more comfortable recovery, there are many scenarios in which these procedures are not possible. These include, but are not limited to, cases of corneal instability, previous refractive surgery, or transplant where higher-order aberrations can impair vision in a manner not amenable to spectacle or contact lens correction. We discuss refinements to the procedure that would help improve outcomes, including optimising patient discomfort after surgery as well as reducing corneal haze and refractive regression.

This study analyzed the impact of corneal epithelial refraction on the correction of hyperopic and mixed astigmatism eyes treated with transepithelial photorefractive keratectomy. From the epithelial refraction provided by the diagnostic device, OCT correlations were evaluated with respect to manifest refraction. The postoperative outcomes showed a mean sphere of −0.03 D and a mean cylinder of −0.33 D, with 93% and 98% having 0.5 D, 1 D, or less spherical equivalent refractive error. The epithelium showed preoperative toricity: at 6 mm, the epithelium showed a compensational effect of ~15% for the refractive astigmatism, whereas at 3 mm, the compensation accounted for ~25% of the refractive astigmatism. No correlation was found between preoperative epithelial refraction and refractive deviation after hyperopic or mixed astigmatic transepithelial photorefractive treatment. This work provides insight into the refractive compensatory impact of the epithelium, suggests how one can benefit from that in transepithelial corrections, and sets a framework for the potential induction of errors in non-transepithelial corrections.

(1) Introduction: We analysed epithelial changes after the treatment of moderate myopia with transepithelial photorefractive keratectomy. (2) Materials and Methods: We used optical coherence tomography data and analysed changes in the stroma and epithelium after ablation. We aimed to ascertain how much epithelium hyperplasia occurred after TransPRK; for this, we used data from 50 eyes treated with TransPRK with the AMARIS 1050 Hz, with a minimum follow-up of 4 months. (3) Results: The measured epithelial changes corresponded to a less than 0.1 ± 0.2D of spherical effect, less than 0.2 ± 0.2D of astigmatic effect, and less than 0.5 ± 0.2D of comatic effect. (4) Conclusions: The changes in epithelial thickness after aberration-neutral transepithelial photorefractive keratectomy for moderate myopia were very small, indicating a low level of epithelial hyperplasia without resembling a regression-inducing lentoid.

Background In eyes with hyperopia, astigmatism, and mixed astigmatism Transepithelial photorefractive keratectomy (TransPRK) is a modality of surface ablation surgery. We center on the corneal vertex for all our treatments (all have an offset to the center of the pupil) and wanted to compare the visual results of symmetrical profile treatments versus asymmetrical profile treatments (the center of the treatment on the vertex and the boundaries with the pupil center) using TransPRK as corneal refractive surgery. Methods We retrospectively analyzed two consecutive groups of eyes treated with TransPRK in the Aurelios Augenlaserzentrum Recklinghausen: 47 eyes treated with symmetrical offset and 51 eyes treated with asymmetrical offset. The intergroup comparisons were assessed using unpaired Student’s T-tests, whereas preoperative to postoperative changes were assessed using paired Student’s T-tests. Results Refractive outcomes were good for both groups. 83 and 88% of eyes were within the spherical equivalent of 0.5 D from the target in the symmetric and asymmetric offset groups, respectively. 85 and 84% of eyes had a postoperative astigmatism of 0.5 D or lower in the symmetric and asymmetric offset groups, respectively. Conclusion We have not found a significant difference in the refractive outcomes between the symmetric group and the asymmetric group of eyes treated both with TransPRK for preoperatively hyperopic or mixed astigmatism.

Background TransPRK, SMILE, and FS-LASIK are widely used surgical procedures for myopia correction, but differences in postoperative visual quality and optical zone design remain a subject of clinical interest. This study aimed to compare visual outcomes, higher-order aberrations (HOAs), contrast sensitivity, optical zone diameter, and corneal biomechanics among these three techniques. Methods In this prospective cohort study, 82 patients (164 eyes) with myopia were randomly assigned to undergo TransPRK ( n  = 56 eyes), SMILE ( n  = 52 eyes), or FS-LASIK ( n  = 56 eyes). All procedures were performed at a single center, and patients were followed for six months postoperatively. Outcome measures included uncorrected visual acuity (UCVA), HOAs, contrast sensitivity under both bright and dark conditions, optical zone diameter, refractive error, corneal biomechanical parameters (corneal hysteresis and resistance factor), and subjective symptoms such as nighttime glare and halos. Statistical analysis involved ANOVA and chi-square tests. Results At six months, all groups achieved comparable UCVA (≥ 96% achieving ≥ 1.0), but the TransPRK group demonstrated significantly lower total HOAs (0.25 ± 0.07 μm) and spherical aberrations (+ 0.05 ± 0.02 μm) than SMILE and FS-LASIK ( P  < 0.001). TransPRK also showed superior contrast sensitivity, particularly in low-light conditions (6 cpd: 1.05 ± 0.12 log units, P  < 0.001). All techniques demonstrated comparable efficacy (indices > 1.0), with non-significant trends favoring SMILE for UCVA (98.08%) and TransPRK for refractive stability (-0.12 ± 0.25D; all P  > 0.05). The SMILE group preserved the best corneal biomechanics (CH: 10.1 ± 1.1 mmHg; CRF: 10.5 ± 1.3 mmHg), while FS-LASIK had the highest incidence of nighttime glare (26.8%) and halos (23.2%) ( P  < 0.05). Conclusions TransPRK has good postoperative visual quality, but its advantages may be mediated by its larger optical zone design. In terms of night vision performance, SMILE surgery can effectively preserve the biomechanical properties of the cornea, while FS-LASIK achieved comparable 6-month acuity; we did not assess time-to-recovery. Selection of surgical modality should be individualized based on patient-specific anatomical and lifestyle factors.

To compare the visual and refractive results obtained after two-step TransPRK using an EX500 excimer laser for low to moderate myopic correction in adolescents and adults. Retrospectively, 91 eyes of 52 patients were categorized into four groups based on age and level of myopia. The demographics, data of efficacy, safety, predictability, stability, and post-operative complications were evaluated at 1, 3, 6, and 12 months post-operatively. At 1-month, adolescents with low myopia achieved the highest mean efficacy index (P =0.034). The efficacy indices continuously increased during the 1-year follow-up in all groups, except in adolescents with moderate myopia. The highest safety and efficacy indices were recorded in adolescents with low myopia at 1-year. Post-operative spherical equivalent within ±0.50 D at 1 year was 48.75% of all treated eyes; however, the final mean refractive spherical equivalent (MRSE) was under-corrected in all groups. By month 3, the percentage of eyes that had grade 0.5 haze was most prevalent in adolescents with moderate myopia (P <0.001). two-step TransPRK using an EX500 proved to be an effective, predictable, stable and safe procedure for the correction of low to moderate myopia with or without astigmatism at 1 year. Adolescents with low myopia achieved the best-post-operative UDVA, efficacy and safety indices. Adolescents tolerated night visual problems and dry eye symptoms better than adults.

Background To evaluate the safety, efficacy, and the refractive outcomes of single-step transepithelial photorefractive keratectomy (TransPRK) for the correction of mild, moderate, and high myopia. Methods This study consecutively recruited 32 high myopic eyes, 32 mild myopic and 32 moderate myopic eyes. Eyes with myopia that had undergone TransPRK treatment. Pre- and post-operative visual and refractive data, corneal Higher Order Aberration (HOA) as well as safety and efficacy indices were analyzed at 6 months postoperatively. Results Six months after TransPRK, the manifest refraction spherical equivalent (SE) was not significantly between high myopia group and moderate myopia group ( p = 0.636). No eyes lost ≥2 lines of corrected distant visual acuity (CDVA) in high myopic eyes. The uncorrected distance visual acuity (UDVA) was significantly higher in low and moderate myopia groups than the high myopia group ( P < 0.001; P = 0.002). The CDVA was not significantly different between moderate and high myopia groups ( P  = 0.057). There was no significant difference in mean safety index between high myopia group (1.01 ± 0.14) and mild myopia group (1.08 ± 0.15) ( P > 0.05). The mean safety index was significantly higher in the moderate myopia group (1.16 ± 0.23) than in the high myopia group (1.01 ± 0.14) ( P = 0.002). The efficacy index was significantly higher in the moderate myopia group (1.05 ± 0.20) than in the high myopia group (0.89 ± 0.17) ( P = 0.02), and there was no significant difference between the high myopia group (0.89 ± 0.17) and the low myopia group (0.96 ± 0.16) ( P  = 0.14). Conclusions The mean safety index was over 1.0 in the three groups. TransPRK showed acceptable safety and efficacy in the moderate myopic eyes, as well as mild and high myopic eyes. High myopic eyes got very similar refractive results with moderate myopic eyes six months postoperatively. The safety and efficacy indexes were not significantly different between the high myopia group and the low myopia group.

Purpose: We evaluated the refractive visual outcomes and efficacy of Transepithelial Photorefractive Keratectomy (TransPRK) using Smart Pulse Technology with static and dynamic cyclotorsion and the AMARIS 1050 Hz RS laser platform from Schwind in the eyes after a refractive lens exchange. Setting/Venue: Aurelios Augenlaserzentrum, Recklinghausen. Methods: We retrospectively evaluated the data of 552 consecutive eyes treated with refractive lens exchange between 2016 and 2019. A total of 47 eyes (8.5%) required a touch up after the clear lens exchange. From 43 eyes of 43 patients, we obtained a minimum follow up of 3 months. In all cases, we performed a TransPRK with a minimum optical zone of 7.2 mm, centering the ablation on the vertex of the cornea. Results: The average age of the treated eyes was 57 years old, with a range between 48 and 68 years. The mean treated sphere was 0.42 diopters (D), with a range between −1.0 and +1.75 D. The mean astigmatism was 1.06 D. Postoperatively, after laser vision correction, we reduced the sphere to a mean of 0.11 D (range −0.5 to +0.75 D), and, postoperatively, the mean astigmatism was 0.25 D (range −0.75 to 0 D). The predictability for a spheric equivalent (SEQ) of 0.5 D was 91%, and for 1 D it was 100% of the cases. No eye lost more than one Snellen line. Conclusions: TransPRK with smart pulse was predictable for correcting ametropia after Clear Lens Surgery.

Is it possible to obtain good results in myopia of 2 or fewer diopters (D) with transepithelial photorefractive keratectomy (TransPRK) changing the optical zone and epithelium thickness? We retrospectively analyzed two groups of 296 eyes with a minimum follow-up of 4 months. Group A had 2 or less D, treated with an optical zone (OZ) 0.2 mm bigger than recommended, and a central epithelium thickness of 60 microns, and group B had 2 D to 5 D, with the recommended optical zone, and a 55-micron epithelium ablation at the center. The outcomes were not different between the two myopic ranges; the postop uncorrected distance visual acuity was 20/20 ± 4 in both groups (p = 0.2), which was −0.3 ± 0.8 lines worse than the preoperative corrected distance visual acuity in both groups (p = 0.5). The safety of the treatments resulted in a change of 0.0 ± 0.7 lines in the low myopia group, versus a gain of +0.1 ± 0.8 lines in the moderate myopia group (p = 0.1). The deviation from the intended target was −0.04 ± 0.33 D in the low myopia group and +0.07 ± 0.32 D in the moderate myopia group (p < 0.0001); the postoperative spherical equivalent was 0.00 ± 0.33 D in the low myopia group and +0.10 ± 0.31 D in the moderate myopia group (p < 0.0001). The postop refractive astigmatism was 0.32 ± 0.16 D in both groups (p = 0.5). In conclusion, the refractive and visual outcomes after TransPRK are comparable in low myopia changing the optical zone and epithelium thickness versus moderate myopia with standard optical zone and epithelium thickness.