Transepithelial Versus Epithelium-off Photorefractive Keratectomy in High Compound Myopic Astigmatism: A Contralateral Eye Study.

Purpose: To compare clinical outcomes of transepithelial photorefractive keratectomy (t-PRK) and conventional epithelium-off PRK (PRK) in patients with high compound myopic astigmatism.

Methods: Sixty eyes of 30 myopic individuals with at least -2.50 diopters (D) of spherical equivalent and 3.00 D of cylindrical refractive error were enrolled in the study. Both eyes of each patient were randomly assigned to either the t-PRK method or epithelium-off PRK as a matched contralateral control group. Refractive outcomes were evaluated 6 months after surgery.

Results: At the 6-month visit, cylindrical refractive error magnitude was lower in the t-PRK (0.51 ± 0.29 D) compared to the PRK (0.67 ± 0.30 D) group (P = .04). The residual astigmatism was 0.50 diopters or less in 23 eyes (76%) in the t-PRK group and 15 eyes (50%) in the PRK group. In vector analysis using the Alpins method, t-PRK resulted in a significantly higher percentage of success of astigmatic surgery (84.68 ± 8.95 in t-PRK versus 79.46 ± 10.88 in PRK, P = .04). Additionally, there was a marginal advantage for the t-PRK group regarding index of success of astigmatism surgery (P = .06) and absolute (P = .08) and arithmetic (P = .07) angles of error compared to the PRK group. Both groups had an equal safety profile.

Conclusions: T-PRK is more accurate for astigmatic correction in high astigmatism than conventional PRK. Both t-PRK and PRK are comparable respecting safety and efficacy. [J Refract Surg. 2024;40(12):e956-e965.].