Comparison of postoperative pain following laser-assisted subepithelial keratectomy and transepithelial photorefractive keratectomy: a prospective, random paired bilateral eye study.

Purpose: To compare postoperative pain following laser-assisted subepithelial keratectomy (LASEK) and transepithelial photorefractive keratectomy (T-PRK, two-step surgery) and alleviate postoperative subjective pain.

Methods: Thirty patients (60 eyes) with myopia or myopic astigmatism were consecutively recruited into this prospective, randomized paired study. Patients underwent LASEK in one eye, and T-PRK in the other. The degree of pain was rated on a scale of 0-10 on postoperative days 1, 2 and 3. Uncorrected visual acuity (UCVA) and subepithelial corneal haze were assessed at postoperative 1 and 3 months.

Results: The pain was relieved on the 4th postoperative day in all patients, healing of corneal epithelium was observed at 4-5 days after surgery and contact lenses were removed promptly. At postoperative 1 day, the mean subjective pain score in the LASEK group was 3.2 ± 1.88 and 4.43 ± 1.61 in T-PRK group (P = 0.008). No significant difference was found between two groups on postoperative 2 and 3 days. At postoperative 3 months, the percentage of UCVA ≥ 0.8 in the LASEK group was 100% and 96.7% in the T-PRK group (P = 0.24), 93.3% of patients in the LASEK with UCVA ≥ 1.0 and 90% in the T-PRK group (P = 0.64). In the LASEK group, the value of corneal haze was 0.26 ± 0.21 and 0.27 ± 0.25 in the T-PRK group (P = 0.877).

Conclusion: Good visual acuity was obtained in both groups at postoperative 3 months. Compared with those in the T-PRK group, patients undergoing had less discomfort in the LASEK group, which may be associated with corneal epithelial activity. The changing curve of subjective pain in the T-PRK group was relatively flat and stable at postoperative 3 days.