PURPOSE: This prospective, randomized, single-surgeon study evaluated the safety and efficacy outcomes of transepithelial photoreactive keratectomy (tPRK) compared with conventional photoreactive keratectomy (PRK) at 3 years of follow-up.

METHODS: Thirty-five patients who underwent refractive surgery for correction of ametropia were evaluated. Patients were bilaterally treated with PRK in one eye and tPRK in the other. Clinical endpoints include absolute refractive predictability, adverse events (AEs), manifest refraction spherical equivalent (MRSE), monocular uncorrected and corrected distance visual acuity (UDVA/CDVA) and patient-reported visual outcomes at 36 months.

RESULTS: Both treatment approaches achieved excellent efficacy and safety with no statistically significant differences between study groups. Median photopic UDVA was 0.0 logMAR (range -0.20 to +0.50) and median photopic CDVA -0.10 logMAR (range -0.20 to 0.00); median mesopic UDVA was 0.0 logMAR (range -0.10 to -0.50) and mesopic CDVA -0.10 logMAR (range -0.10 to -0.40). Median MRSE was close to plano in both arms (range -0.50 D to +0.50 D). Contrast sensitivity remained comparable under both photopic and mesopic conditions. Intraocular pressure was comparable and unremarkable, and no haze or adverse events were reported.

CONCLUSION: The tPRK procedure offers the surgeon improved speed and efficiency over conventional PRK. In this analysis, tPRK provided outcomes equivalent to conventional PRK in terms of refractive predictability, visual acuity, and contrast sensitivity. Both procedures were well tolerated, effective, and stable through 36 months.