This prospective, randomized, single-surgeon study evaluated the long-term safety, efficacy, and refractive stability of transepithelial photorefractive keratectomy (tPRK) compared with conventional photorefractive keratectomy (PRK), with follow-up to 36 months. Thirty-five patients undergoing refractive correction for ametropia received tPRK in one eye and conventional PRK in the contralateral eye. Outcomes assessed included manifest refraction spherical equivalent (MRSE), monocular uncorrected and corrected distance visual acuity (UDVA and CDVA), refractive predictability, adverse events, and patient-reported visual outcomes.

At 36 months, both groups demonstrated sustained visual and refractive stability. Mean (SD) photopic UDVA was −0.02 (± 0.09) logMAR for tPRK and 0.03 (± 0.14) logMAR for PRK, while mean photopic CDVA was −0.06 (± 0.06) logMAR and −0.05 (± 0.06) logMAR, respectively. Under mesopic conditions, mean UDVA was 0.01 (± 0.12) logMAR for tPRK and 0.03 (± 0.15) logMAR for PRK, and mean CDVA was −0.03 (± 0.10) logMAR and −0.05 (± 0.05) logMAR, respectively. Mean MRSE was 0.03D (±0.37) and –0.14D (±0.39) at 6 months for tPRK and PRK, respectively – and remained close to plano out to 36 months (−0.24D [± 0.31] and −0.31D [± 0.38], respectively). No eyes experienced clinically significant CDVA loss, intraocular pressure remained within normal limits, and no visually significant corneal haze was observed. Contrast sensitivity remained stable and comparable under photopic and mesopic conditions.

Overall, tPRK demonstrated visual and refractive outcomes equivalent to conventional PRK through 36 months, supporting its long-term effectiveness as a surface ablation technique with procedural advantages in terms of speed and efficiency.