Efficacy, safety, and predictability of transepithelial vs mechanical or alcohol-assisted photorefractive keratectomy: meta-analysis.

TOPIC: The aim of this study was to assess the meta-analysis of the studies comparing transepithelial photorefractive keratectomy (transPRK) with classic photorefractive keratectomy (PRK) (mechanical or alcohol-assisted).

CLINICAL RELEVANCE: Although PRK is a well-established procedure, transPRK, a newer, minimally invasive technique may reduce surgery time and improve patient outcomes. Comparing these techniques helps optimize surgical choices.

METHODS

Relevant studies were collected from PubMed and were included if they met the following criteria: comparison of transPRK and PRK in efficacy, safety, predictability, correction index, difference vector, or index of success. The odds ratio (OR) estimates, risk ratio, and 95% CIs were derived from random-effects meta-analysis.

RESULTS

20 studies with a total of 10 204 treated eyes were included in this meta-analysis. The pooled estimates between transPRK and PRK were as follows: log(OR) of the efficacy had a value of 0 (CI -0.32 to 0.33), log(OR) of the safety was 0.04 (CI -0.98 to 1.06), and log(OR) of the predictability was 0.48 (CI 0.16-0.81).

CONCLUSIONS

This meta-analysis showed that there were no statistically significant differences in either of the visual outcomes (efficacy, efficacy index, safety, safety index, and predictability). Although transPRK is preferred for its minimally invasive approach and quicker recovery, PRK continues to be a reliable option, particularly in environments where advanced technology is not easily affordable. The choice of laser platform can also influence the surgical outcomes through features such as advanced pulse technology, optimized ablation speed, and profiles.