Trans-Epithelial Photorefractive Keratectomy in the Treatment of Myopia, Hyperopia and Astigmatism: Five-Year Results
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Abstract
We aimed to report the five-year results of Trans-epithelial Photorefractive Keratectomy (TPRK) in treating all kinds of refractive errors. In this retrospective cohort study, we quantitatively compared the clinical findings and assessment of optical and refractive parameters, including slit-lamp, corneal topography, Best Corrected Visual Acuity (BCVA), and Uncorrected Distance Visual Acuity (UDVA) in 172 eyes of myopic, hyperopic, and astigmatic patients before and five years after trans-PRK. The average time for post-surgery epithelial healing was 2.97 0.83 days in male and 2.94 0.87 days in female patients; the pain score in a week following the operation was 1.88 0.68 in males and 2.25 0.73 in females. Corneal haze was observed in five patients. No long-term adverse effect was reported. The pre-operative UDVA was 0.84 0.32 in male and 0.87 0.34 in female patients; while the postoperative UDVA was -0.02 0.04 in male and -0.01 0.02 in female patients. There was a highly significant correlation (P<0.001) in all indices except UDVA, which was almost near to being significant (P=0.07). In this survey, the mean safety and index were nearly 1.00. TPRK is a safe and efficient therapeutic procedure to treat all types of refractive errors, including myopia, hyperopia, and astigmatism, with no significant adverse effect. Being touchless and having a short recovery time are two main characteristics of this refractive surgery.
1.Hashemi H, Fotouhi A, Yekta A, Pakzad R, Ostadimoghaddam H, Khabazkhoob M. Global and regional estimates of prevalence of refractive errors: systematic review and meta-analysis. Journal of current ophthalmology. 2018;30(1):3-22.
2.Naidoo KS, Jaggernath J. Uncorrected refractive errors. Indian journal of ophthalmology. 2012;60(5):432.
3.Pascolini D, Mariotti SP. Global estimates of visual impairment: 2010. British Journal of Ophthalmology. 2012;96(5):614-8.
4.Bourne RR, Dineen BP, Huq DMN, Ali SM, Johnson GJ. Correction of refractive error in the adult population of Bangladesh: meeting the unmet need. Investigative ophthalmology & visual science. 2004;45(2):410-7.
5.Kahuam‐López N, Navas A, Castillo‐Salgado C, Graue‐Hernandez EO, Jimenez‐Corona A, Ibarra A. Laser‐assisted in‐situ keratomileusis (LASIK) with a mechanical microkeratome compared to LASIK with a femtosecond laser for LASIK in adults with myopia or myopic astigmatism. Cochrane Database of Systematic Reviews. 2020(4).
6.Cochrane GM, du Toit R, Le Mesurier RT. Management of refractive errors. Bmj. 2010;340:c1711.
7.Etim BA, Oraegbunam NH, Ibanga AA, Okonkwo SN. Perception of Refractive Errors and Impact of Corrective Treatments on Adult Patients Seen at a Tertiary Health Institution in South-South Nigeria. Journal of Advances in Medicine and Medical Research. 2018:1-11.
8.Congdon N, Zheng M, Sharma A, Choi K, Song Y, Zhang M, et al. Prevalence and determinants of spectacle nonwear among rural Chinese secondary schoolchildren: the Xichang Pediatric Refractive Error Study Report 3. Archives of ophthalmology. 2008;126(12):1717-23.
9.Megbelayin EO. Barriers to uptake of prescribed refractive spectacles amongst Nigerian students. Int Res J Basic Clin Stud. 2013;1(5):71-7.
10.Yu L, Li Z-K, Gao J-R, Liu J-R, Xu C-T. Epidemiology, genetics and treatments for myopia. International journal of ophthalmology. 2011;4(6):658.
11.del Barrio JLA, Wilkins M, Cochener B, Ang M. Refractive surgery. The Lancet. 2019;393(10185):2085-98.
12.Azar DT. Refractive Surgery E-Book: Elsevier Health Sciences; 2019.
13.Frings A, Richard G, Steinberg J, Druchkiv V, Linke SJ, Katz T. LASIK and PRK in hyperopic astigmatic eyes: is early retreatment advisable? Clinical ophthalmology (Auckland, NZ). 2016;10:565.
14.Wilkinson JM, Cozine EW, Kahn AR. Refractive Eye Surgery: Helping Patients Make Informed Decisions About LASIK. American family physician. 2017;95(10):637-44.
15.Tsai T-H, Peng K-L, Lin C-J. Traumatic corneal flap displacement after laser in situ keratomileusis (LASIK). International medical case reports journal. 2017;10:143.
16.Fogla R, KRao S, Padmanabhan P. LASIK—Complications and Management. Gems of Ophthalmology: Cornea & Sclera. 2018:114.
17.Bastawrous A, Silvester A, Batterbury M. Laser refractive eye surgery. BMJ. 2011;342:d2345.
18.Seiler T, McDonnell PJ. Excimer laser photorefractive keratectomy. Survey of ophthalmology. 1995;40(2):89-118.
19.Somani SN, Moshirfar M, Patel BC. Photorefractive Keratectomy (PRK). StatPearls [Internet]: StatPearls Publishing; 2019.
20.Tomás-Juan J, Larranaga AM-G, Hanneken L. Corneal regeneration after photorefractive keratectomy: a review. Journal of optometry. 2015;8(3):149-69.
21.Erie JC, Patel SV, McLaren JW, Hodge DO, Bourne WM. Keratocyte density in the human cornea after photorefractive keratectomy. Archives of Ophthalmology. 2003;121(6):770-6.
22.Ghoreishi M, Attarzadeh H, Tavakoli M, Moini HA, Zandi A, Masjedi A, et al. Alcohol-assisted versus mechanical epithelium removal in photorefractive keratectomy. Journal of ophthalmic & vision research. 2010;5(4):223.
23.Gimbel HV, DeBroff BM, Beldavs RA, van Westenbrugge JA, Ferensowicz M. Comparison of laser and manual removal of corneal epithelium for photorefractive keratectomy. Journal of refractive surgery. 1995;11(1):36-67.
24.Clinch TE, Moshirfar M, Weis JR, Ahn CS, Hutchinson CB, Jeffrey JH. Comparison of mechanical and transepithelial debridement during photorefractive keratectomy. Ophthalmology. 1999;106(3):483-9.
25.Kanellopoulos AJ, Binder PS. Management of corneal ectasia after LASIK with combined, same-day, topography-guided partial transepithelial PRK and collagen cross-linking: the Athens protocol. Journal of Refractive Surgery. 2011;27(5):323-31.
26.Melki SA, Azar DT. LASIK complications: etiology, management, and prevention. Survey of ophthalmology. 2001;46(2):95-116.
27.Campos M, Raman S, Lee M, McDonnell PJ. Keratocyte loss after different methods of de-epithelialization. Ophthalmology. 1994;101(5):890-4.
28.Lee HK, Lee KS, Kim JK, Kim HC, Seo KR, Kim EK. Epithelial healing and clinical outcomes in excimer laser photorefractive surgery following three epithelial removal techniques: mechanical, alcohol, and excimer laser. American journal of ophthalmology. 2005;139(1):56-63.
29.Campos M, Hertzog L, Wang XW, Fasano AP, McDonnell PJ. Corneal surface after deepithelialization using a sharp and a dull instrument. Ophthalmic Surgery, Lasers and Imaging Retina. 1992;23(9):618-21.
30.Hanna KD, Pouliquen YM, Waring GO, Savoldelli M, Fantes F, Thompson KP. Corneal wound healing in monkeys after repeated excimer laser photorefractive keratectomy. Archives of Ophthalmology. 1992;110(9):1286-91.
31.Fantes FE, Hanna KD, Waring GO, Pouliquen Y, Thompson KP, Savoldelli M. Wound healing after excimer laser keratomileusis (photorefractive keratectomy) in monkeys. Archives of Ophthalmology. 1990;108(5):665-75.
32.Melzack R. The McGill Pain Questionnaire: major properties and scoring methods. pain. 1975;1(3):277-99.
33.Mosquera SA, Awwad ST. Theoretical analyses of the refractive implications of transepithelial PRK ablations. British Journal of Ophthalmology. 2013;97(7):905-11.
34.Fadlallah A, Fahed D, Khalil K, Dunia I, Menassa J, El Rami H, et al. Transepithelial photorefractive keratectomy: clinical results. Journal of Cataract & Refractive Surgery. 2011;37(10):1852-7.
35.Adib-Moghaddam S, Arba-Mosquera S, Walter-Fincke R, Soleyman-Jahi S, Adili-Aghdam F. Transepithelial photorefractive keratectomy for hyperopia: a 12-month bicentral study. Journal of Refractive Surgery. 2016;32(3):172-80.
36.Luger MH, Ewering T, Arba-Mosquera S. Consecutive myopia correction with transepithelial versus alcohol-assisted photorefractive keratectomy in contralateral eyes: one-year results. Journal of Cataract & Refractive Surgery. 2012;38(8):1414-23.
37.Naderi M, Jadidi K, Mosavi SA, Daneshi SA. Transepithelial photorefractive keratectomy for low to moderate myopia in comparison with conventional photorefractive keratectomy. Journal of ophthalmic & vision research. 2016;11(4):358-62
2.Naidoo KS, Jaggernath J. Uncorrected refractive errors. Indian journal of ophthalmology. 2012;60(5):432.
3.Pascolini D, Mariotti SP. Global estimates of visual impairment: 2010. British Journal of Ophthalmology. 2012;96(5):614-8.
4.Bourne RR, Dineen BP, Huq DMN, Ali SM, Johnson GJ. Correction of refractive error in the adult population of Bangladesh: meeting the unmet need. Investigative ophthalmology & visual science. 2004;45(2):410-7.
5.Kahuam‐López N, Navas A, Castillo‐Salgado C, Graue‐Hernandez EO, Jimenez‐Corona A, Ibarra A. Laser‐assisted in‐situ keratomileusis (LASIK) with a mechanical microkeratome compared to LASIK with a femtosecond laser for LASIK in adults with myopia or myopic astigmatism. Cochrane Database of Systematic Reviews. 2020(4).
6.Cochrane GM, du Toit R, Le Mesurier RT. Management of refractive errors. Bmj. 2010;340:c1711.
7.Etim BA, Oraegbunam NH, Ibanga AA, Okonkwo SN. Perception of Refractive Errors and Impact of Corrective Treatments on Adult Patients Seen at a Tertiary Health Institution in South-South Nigeria. Journal of Advances in Medicine and Medical Research. 2018:1-11.
8.Congdon N, Zheng M, Sharma A, Choi K, Song Y, Zhang M, et al. Prevalence and determinants of spectacle nonwear among rural Chinese secondary schoolchildren: the Xichang Pediatric Refractive Error Study Report 3. Archives of ophthalmology. 2008;126(12):1717-23.
9.Megbelayin EO. Barriers to uptake of prescribed refractive spectacles amongst Nigerian students. Int Res J Basic Clin Stud. 2013;1(5):71-7.
10.Yu L, Li Z-K, Gao J-R, Liu J-R, Xu C-T. Epidemiology, genetics and treatments for myopia. International journal of ophthalmology. 2011;4(6):658.
11.del Barrio JLA, Wilkins M, Cochener B, Ang M. Refractive surgery. The Lancet. 2019;393(10185):2085-98.
12.Azar DT. Refractive Surgery E-Book: Elsevier Health Sciences; 2019.
13.Frings A, Richard G, Steinberg J, Druchkiv V, Linke SJ, Katz T. LASIK and PRK in hyperopic astigmatic eyes: is early retreatment advisable? Clinical ophthalmology (Auckland, NZ). 2016;10:565.
14.Wilkinson JM, Cozine EW, Kahn AR. Refractive Eye Surgery: Helping Patients Make Informed Decisions About LASIK. American family physician. 2017;95(10):637-44.
15.Tsai T-H, Peng K-L, Lin C-J. Traumatic corneal flap displacement after laser in situ keratomileusis (LASIK). International medical case reports journal. 2017;10:143.
16.Fogla R, KRao S, Padmanabhan P. LASIK—Complications and Management. Gems of Ophthalmology: Cornea & Sclera. 2018:114.
17.Bastawrous A, Silvester A, Batterbury M. Laser refractive eye surgery. BMJ. 2011;342:d2345.
18.Seiler T, McDonnell PJ. Excimer laser photorefractive keratectomy. Survey of ophthalmology. 1995;40(2):89-118.
19.Somani SN, Moshirfar M, Patel BC. Photorefractive Keratectomy (PRK). StatPearls [Internet]: StatPearls Publishing; 2019.
20.Tomás-Juan J, Larranaga AM-G, Hanneken L. Corneal regeneration after photorefractive keratectomy: a review. Journal of optometry. 2015;8(3):149-69.
21.Erie JC, Patel SV, McLaren JW, Hodge DO, Bourne WM. Keratocyte density in the human cornea after photorefractive keratectomy. Archives of Ophthalmology. 2003;121(6):770-6.
22.Ghoreishi M, Attarzadeh H, Tavakoli M, Moini HA, Zandi A, Masjedi A, et al. Alcohol-assisted versus mechanical epithelium removal in photorefractive keratectomy. Journal of ophthalmic & vision research. 2010;5(4):223.
23.Gimbel HV, DeBroff BM, Beldavs RA, van Westenbrugge JA, Ferensowicz M. Comparison of laser and manual removal of corneal epithelium for photorefractive keratectomy. Journal of refractive surgery. 1995;11(1):36-67.
24.Clinch TE, Moshirfar M, Weis JR, Ahn CS, Hutchinson CB, Jeffrey JH. Comparison of mechanical and transepithelial debridement during photorefractive keratectomy. Ophthalmology. 1999;106(3):483-9.
25.Kanellopoulos AJ, Binder PS. Management of corneal ectasia after LASIK with combined, same-day, topography-guided partial transepithelial PRK and collagen cross-linking: the Athens protocol. Journal of Refractive Surgery. 2011;27(5):323-31.
26.Melki SA, Azar DT. LASIK complications: etiology, management, and prevention. Survey of ophthalmology. 2001;46(2):95-116.
27.Campos M, Raman S, Lee M, McDonnell PJ. Keratocyte loss after different methods of de-epithelialization. Ophthalmology. 1994;101(5):890-4.
28.Lee HK, Lee KS, Kim JK, Kim HC, Seo KR, Kim EK. Epithelial healing and clinical outcomes in excimer laser photorefractive surgery following three epithelial removal techniques: mechanical, alcohol, and excimer laser. American journal of ophthalmology. 2005;139(1):56-63.
29.Campos M, Hertzog L, Wang XW, Fasano AP, McDonnell PJ. Corneal surface after deepithelialization using a sharp and a dull instrument. Ophthalmic Surgery, Lasers and Imaging Retina. 1992;23(9):618-21.
30.Hanna KD, Pouliquen YM, Waring GO, Savoldelli M, Fantes F, Thompson KP. Corneal wound healing in monkeys after repeated excimer laser photorefractive keratectomy. Archives of Ophthalmology. 1992;110(9):1286-91.
31.Fantes FE, Hanna KD, Waring GO, Pouliquen Y, Thompson KP, Savoldelli M. Wound healing after excimer laser keratomileusis (photorefractive keratectomy) in monkeys. Archives of Ophthalmology. 1990;108(5):665-75.
32.Melzack R. The McGill Pain Questionnaire: major properties and scoring methods. pain. 1975;1(3):277-99.
33.Mosquera SA, Awwad ST. Theoretical analyses of the refractive implications of transepithelial PRK ablations. British Journal of Ophthalmology. 2013;97(7):905-11.
34.Fadlallah A, Fahed D, Khalil K, Dunia I, Menassa J, El Rami H, et al. Transepithelial photorefractive keratectomy: clinical results. Journal of Cataract & Refractive Surgery. 2011;37(10):1852-7.
35.Adib-Moghaddam S, Arba-Mosquera S, Walter-Fincke R, Soleyman-Jahi S, Adili-Aghdam F. Transepithelial photorefractive keratectomy for hyperopia: a 12-month bicentral study. Journal of Refractive Surgery. 2016;32(3):172-80.
36.Luger MH, Ewering T, Arba-Mosquera S. Consecutive myopia correction with transepithelial versus alcohol-assisted photorefractive keratectomy in contralateral eyes: one-year results. Journal of Cataract & Refractive Surgery. 2012;38(8):1414-23.
37.Naderi M, Jadidi K, Mosavi SA, Daneshi SA. Transepithelial photorefractive keratectomy for low to moderate myopia in comparison with conventional photorefractive keratectomy. Journal of ophthalmic & vision research. 2016;11(4):358-62
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| Issue | Vol 60 No 10 (2022) | |
| Section | Articles | |
| DOI | https://doi.org/10.18502/acta.v60i10.11557 | |
| Keywords | ||
| Transepithelial photorefractive keratectomy Transepithelial photorefractive keratectomy (Trans-PRK) Myopia Hyperopia Astigmatism | ||
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How to Cite
1.
Hasani H, Khavandegar A, Adhami P, Saberdoust F. Trans-Epithelial Photorefractive Keratectomy in the Treatment of Myopia, Hyperopia and Astigmatism: Five-Year Results. Acta Med Iran. 2022;60(10):640-645.
