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Weng TH, Chang YM, Lin FH, Weng ZX, Wang TW, Chen YH, Tai MC, Chen JT, Liang CM, Lin TY. Investigation of corneal epithelial thickness and irregularity by optical coherence tomography after transepithelial photorefractive keratectomy. Clin Exp Optom 2024; 107:23-31. [PMID: 37078178 DOI: 10.1080/08164622.2023.2197107] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 03/23/2023] [Indexed: 04/21/2023] Open
Abstract
CLINICAL RELEVANCE Corneal epithelial healing after refractive surgery is a clinically significant issue, especially for surface ablation procedures, and this can be monitored using optical coherence tomography (OCT). BACKGROUND The aim of this work is to investigate the corneal epithelial thickness and irregularity by OCT after transepithelial photorefractive keratectomy (t-PRK) and analyse its correlation with visual and refractive outcomes. METHODS Patients aged ≥18 years with myopia, with or without astigmatism, who underwent t-PRK between May 2020 and August 2021 were included. All participants were subjected to complete ophthalmic examinations and OCT pachymetry at every follow-up visit. Patients were followed up at 1 week and 1, 3, and 6 months postoperatively. RESULTS A total of 67 patients (126 eyes) were enrolled in this study. One month postoperatively, spherical equivalent refraction and visual acuity achieved preliminary stability. However, central corneal epithelial thickness (CCET) and standard deviation of the corneal epithelial thickness (SDcet) took 3-6 months to progressive recovery. Patients with higher baseline spherical equivalent refraction were associated with slower epithelial recovery. At every follow-up time point, a significant superior-inferior difference in the minimum corneal epithelial thickness area was observed. Higher stromal haze was correlated with higher spherical equivalent refraction (both baseline and residual) but had no relation with visual outcomes. There was a significant correlation between higher CCET with a better uncorrected distance visual acuity and lower corneal epithelial thickness irregularity. CONCLUSIONS CCET and SDcet measured by OCT seem to be a good auxiliary indicator for reflecting the status of corneal wound recovery after t-PRK surgery. However, a well-designed randomised control study is needed to confirm the study results.
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Affiliation(s)
- Tzu-Heng Weng
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, Taipei City, Taiwan
- School of Medicine, National Defense Medical Center, Taipei City, Taiwan
| | - Yu-Min Chang
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, Taipei City, Taiwan
- School of Medicine, National Defense Medical Center, Taipei City, Taiwan
| | - Fu-Huang Lin
- School of Public Health, National Defense Medical Center, Taipei City, Taiwan
| | - Zi-Xuan Weng
- School of Public Health, National Defense Medical Center, Taipei City, Taiwan
| | - Tai-Wen Wang
- School of Public Health, National Defense Medical Center, Taipei City, Taiwan
| | - Yi-Hao Chen
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, Taipei City, Taiwan
- School of Medicine, National Defense Medical Center, Taipei City, Taiwan
| | - Ming-Cheng Tai
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, Taipei City, Taiwan
- School of Medicine, National Defense Medical Center, Taipei City, Taiwan
| | - Jiann-Torng Chen
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, Taipei City, Taiwan
- School of Medicine, National Defense Medical Center, Taipei City, Taiwan
| | - Chang-Min Liang
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, Taipei City, Taiwan
- School of Medicine, National Defense Medical Center, Taipei City, Taiwan
| | - Ting-Yi Lin
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, Taipei City, Taiwan
- School of Medicine, National Defense Medical Center, Taipei City, Taiwan
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Abdel-Radi M, Shehata M, Mostafa MM, Aly MOM. Transepithelial photorefractive keratectomy: a prospective randomized comparative study between the two-step and the single-step techniques. Eye (Lond) 2023; 37:1545-1552. [PMID: 35864163 PMCID: PMC10219954 DOI: 10.1038/s41433-022-02174-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 06/16/2022] [Accepted: 07/01/2022] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES To assess and compare the six-month outcome of the two-step transepithelial phototherapeutic keratectomy- photorefractive keratectomy (PTK-PRK) and the single-step transepithelial PRK for myopia and myopic astigmatism. METHODS A prospective randomized study. The study enrolled 100 eyes of 50 patients with mild to moderate myopia or myopic astigmatism stratified into two groups, PTK-PRK (n = 50 eyes) and single step PRK (n = 50 eyes). Primary outcome measures were visual acuity and manifest refraction. Secondary outcome measures were epithelial healing duration, post-PRK pain scores and 3-month postoperative haze grading. RESULTS Preoperative characteristics were similar in both groups (p value > 0.05). The mean uncorrected distance visual acuity (UDVA) at 1 week, 1 month, 3 and 6 months was significantly better in the single-step PRK group than in the two-step PTK-PRK group (p < 0.001). The mean manifest sphere, cylinder and spherical equivalent showed a significant difference at all follow up visits in favour of the single-step PRK (p value < 0.001). Epithelial healing duration was faster in single-step PRK (p value < 0.001). Pain scores were significantly lower following single-step PRK at 8 h, 1 day, 3 days (p value < 0.001) but were similar at the 7th day. Haze scores showed no statistical difference between the two groups at 3-month follow-up. CONCLUSION The two transepithelial PRK techniques were effective in correcting mild to moderate myopia and myopic astigmatism. However, Single-step transepithelial PRK achieved faster visual recovery, better refractive outcome and shorter epithelial healing time with less post-PRK pain. CLINICAL TRIALS REGISTRY (Clinical Trials.gov Identifier): NCT04710082.
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Affiliation(s)
| | - Mohamed Shehata
- Department of Ophthalmology, Assiut University, Assiut, Egypt
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Hashemi H, Alvani A, Aghamirsalim M, Miraftab M, Asgari S. Comparison of transepithelial and conventional photorefractive keratectomy in myopic and myopic astigmatism patients: a randomized contralateral trial. BMC Ophthalmol 2022; 22:68. [PMID: 35148689 PMCID: PMC8832736 DOI: 10.1186/s12886-022-02293-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 02/02/2022] [Indexed: 11/10/2022] Open
Abstract
Background To assess transepithelial photorefractive keratectomy (tPRK) in terms of corneal epithelial healing rate, postoperative pain, postoperative discomfort, and visual and refraction outcomes compared to mechanical epithelial debridement PRK (mPRK) and alcohol-assisted PRK (aaPRK). Methods In this double-masked, randomized clinical trial, thirty-nine patients underwent tPRK in one eye and mPRK in the fellow eye (arm A), and 33 patients underwent tPRK in one eye and aaPRK in the contralateral eye (arm B). All surgical procedures were done using the Schwind Amaris excimer laser. The area of corneal epithelial defect in all eyes was captured and analyzed using ImageJ software. Results Mean epithelial healing time was respectively 3.74 ± 0.82 and 3.59 ± 0.79 days in tPRK versus mPRK (P = 0.21) in arm A, and 3.67 ± 0.92 and 3.67 ± 0.74 days in tPRK versus aaPRK (P = 1.00) in arm B. Accounting for the initial corneal epithelial defect area, the epithelial healing rate was faster in conventional PRK groups compared to tPRK (both P<0.001) in both arms. However, there was no significant difference in safety, efficacy, spherical equivalent refractive accuracy, or corneal haze development between tPRK and conventional PRK groups (all P > 0.05). Conclusions All three methods are effective in terms of visual and refractive outcomes. However, although time to complete re-epithelialization was similar with the three methods, the epithelial healing rate was faster in conventional PRK considering the initial corneal epithelial defect area, and the patients experienced less pain and discomfort in the first postoperative day. Trial registration IRCT, IRCT20200317046804N1. Retrospectively registered 5 May 2020.
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Affiliation(s)
- Hassan Hashemi
- Noor Ophthalmology Research Center, Noor Eye Hospital, 96, Esfandiar Blvd, Valiasr St, Tehran, Tehran, 1968653111, Iran
| | - Azam Alvani
- Noor Ophthalmology Research Center, Noor Eye Hospital, 96, Esfandiar Blvd, Valiasr St, Tehran, Tehran, 1968653111, Iran.
| | | | - Mohammad Miraftab
- Noor Ophthalmology Research Center, Noor Eye Hospital, 96, Esfandiar Blvd, Valiasr St, Tehran, Tehran, 1968653111, Iran
| | - Soheila Asgari
- Noor Ophthalmology Research Center, Noor Eye Hospital, 96, Esfandiar Blvd, Valiasr St, Tehran, Tehran, 1968653111, Iran
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Al-Mohaimeed MM. Effect of the Optical Zone Ablation Diameter on Higher Order Aberrations After Transepithelial Photorefractive Keratectomy: A Cohort Study. Cureus 2021; 13:e17630. [PMID: 34646679 PMCID: PMC8485363 DOI: 10.7759/cureus.17630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To study the effect of the optical zone diameter of ablation on higher order aberrations after transepithelial photorefractive keratectomy for myopia and myopic astigmatism. METHODS In this historical cohort study in 2019, patients were grouped into 7-mm (Gr-1) and 6.5-mm optical zones of ablation (Gr-2). Topographic and higher order aberrations at analysis diameters of 2, 4, and 6 mm were measured before and six months after transepithelial photorefractive keratectomy. The changes in the five types of higher order aberrations in the 6.5 mm and 7 mm groups were compared. The pupillary diameter was correlated with the change in the higher order aberrations. RESULTS We had 24 eyes of 12 patients in Gr-1 and 80 eyes of 40 patients in Gr-2. The trefoil type of higher order aberrations at 6 mm was significantly more prevalent in Gr-2 than in Gr-1 before surgery (p = 0.038). The change in spherical aberration six months after surgery compared with before was significantly more at 6 mm in the eyes of Gr-2 patients (p = 0.02). For the eyes managed by the 7-mm optical zone of ablation for transepithelial photorefractive keratectomy, the decline in the different types of higher order aberrations was significant. The pupillary diameter was positively correlated with the change in the third-order coma in Gr-2 (Spearman coefficient, p = 0.005). All the eyes had an uncorrected visual acuity of 0.0 LogMAR in Gr-1 and 95% in Gr-2 after surgery. CONCLUSIONS The higher order aberrations six months after transepithelial photorefractive keratectomy were similar in eyes managed with 7-mm and 6.5-mm optical zone for ablation. But a lower aberration coefficient in eyes was managed by the 7-mm zone than the 6.5-mm zone of optical ablation at 6-mm analysis diameter.
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Efficacy, safety, and predictability of transepithelial photorefractive keratectomy: meta-analysis. J Cataract Refract Surg 2021; 47:634-640. [PMID: 33252562 DOI: 10.1097/j.jcrs.0000000000000487] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Accepted: 10/08/2020] [Indexed: 01/27/2023]
Abstract
PURPOSE To evaluate the efficacy, safety, and predictability of transepithelial photorefractive keratectomy (TransPRK) for correcting myopia, astigmatism, and hyperopia. SETTING Department of Ophthalmology, Saarland University Medical Center, Homburg/Saar, Germany. DESIGN Meta-analysis of retrospective or prospective studies. METHODS Relevant studies were collected from Medline and included when meeting the following predefined criteria: randomized controlled trials, at least 1 of the main outcome measures as efficacy, safety, or predictability, and 1 common TransPRK laser (Schwind Amaris). The parameters estimates and 95% CI were derived from random-effects meta-analysis to account for possible heterogeneity. RESULTS Because hyperopia studies did not meet the inclusion criteria, the results are centered on myopia and astigmatism. Sixteen studies with a total of 1924 treated eyes were included in the meta-analysis. The mean efficacy, safety, and predictability had a probability of 94% (CI, 0.86-0.97), 0% (CI, 0.00-0.03), and 89% (CI, 0.82-0.93), respectively. The mean correction index, difference vector, and index of success had a value of 1.01 (CI, 1.01-1.02), 0.20 (CI, 0.06-0.34), and 0.12 (CI, 0.07-0.18), respectively. CONCLUSIONS This summary estimate showed that TransPRK was highly effective, safe, and predictable in correcting myopia and/or astigmatism.
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Guneri Beser B, Yildiz E, Turan Vural E. Prognostic factors of visual quality after transepithelial photorefractive keratectomy in patients with low-to-moderate myopia. Indian J Ophthalmol 2020; 68:2940-2944. [PMID: 33229674 PMCID: PMC7856992 DOI: 10.4103/ijo.ijo_279_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose: The aim of this study was to evaluate visual quality after high-frequency transepithelial photorefractive keratectomy (t-PRK) by assessing the relationship between the operational parameters and the first-year postoperative corneal higher-order aberrations (HOAs). Methods: This was a retrospective study of low-to-moderate myopic eyes treated with t-PRK. The files of 46 low-to-moderate myopic patients (90 eyes; myopia up to −5D) were included in the study. Eyes having a cylindrical refractive error more than 2D and the patients not having completed a 1-year follow-up were excluded from the study. Factors including age, preoperative mean spherical equivalent (MSE), mean keratometry (Km), central corneal thickness (CCT), scotopic pupil, optical zone (OZ), transition zone (TZ), ablation zone (AZ), central ablation depth (CAD), and static cyclotorsion correction (SCC) were analyzed for association with the first-year postoperative corneal HOAs. Results: Corneal HOAs were found to be increased postoperatively with a 6-mm pupil (P < 0.05). The increased spherical aberration had a positive correlation with patient age, preoperative MSE, Km, TZ, and CAD, whereas it had a negative relationship with OZ and AZ (P < 0.05). The corneal coma had a significantly positive correlation with preoperative MSE and a significantly negative relationship with OZ (P < .05). Conclusion: Postoperatively induced corneal HOAs may affect patients' scotopic vision (night time driving, cinema) when the pupils get larger. The relationship between patient age, preoperative MSE, Km, CAD, TZ, OZ, AZ, and postoperative corneal HOAs underlines the need to consider the effects of these parameters on the final vision quality.
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Affiliation(s)
- Buse Guneri Beser
- Department of Ophthalmology, Pendik State Hospital, Istanbul, Turkey
| | - Elvin Yildiz
- Department of Ophthalmology, Health Sciences University Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - Ece Turan Vural
- Department of Ophthalmology, Health Sciences University Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
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Clinical outcomes of mechanical and transepithelial photorefractive keratectomy in low myopia with a large ablation zone. J Cataract Refract Surg 2019; 45:977-984. [PMID: 31029476 DOI: 10.1016/j.jcrs.2019.02.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 01/22/2019] [Accepted: 02/09/2019] [Indexed: 11/23/2022]
Abstract
PURPOSE To evaluate the clinical outcomes, vector parameters, and aberrations between mechanical photorefractive keratectomy (PRK) and transepithelial PRK in eyes with low myopia. SETTING Yonsei University College of Medicine and Eyereum Eye Clinic, Seoul, Korea. DESIGN Retrospective, comparative case series. METHODS Eighty-four eyes of 84 patients with low myopia (≤2.00 diopters) were treated with mechanical or transepithelial PRK (41 eyes and 43 eyes, respectively), with the application of a large optical zone (OZ). Visual acuity, manifest refraction, slitlamp evaluation, autokeratometry, corneal topography, and the evaluation of corneal wavefront aberrations were measured preoperatively and at 1, 3, and 6 months after surgery. The efficacy, predictability, vector parameters, corneal aberrations, and safety at 6 months after surgery were compared between the two treatment groups. RESULTS The mean uncorrected distance visual acuity was comparable, at -0.13 ± 0.05 (SD) and -0.15 ± 0.05, in the mechanical and transepithelial PRK groups, respectively, at 6 months after surgery. The safety and efficacy indices, vector parameters, and aberrometric values were also comparable between the two groups. The OZ was large in both groups (7.09 ± 0.20 mm and 7.12 ± 0.27 mm in the mechanical PRK and transepithelial PRK groups, respectively), and showed no significant difference between groups. The corneal total root-mean-square higher-order aberrations and coma significantly reduced after treatment in both groups, and spherical aberrations significantly decreased after transepithelial PRK. CONCLUSIONS Mechanical and transepithelial PRK with a large OZ provided effective and safe outcomes for the correction of low myopia without differences in visual acuity and refractive outcomes between procedures.
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Xi L, Zhang C, He Y. Single-step Transepithelial photorefractive keratectomy in the treatment of mild, moderate, and high myopia: six month results. BMC Ophthalmol 2018; 18:209. [PMID: 30153819 PMCID: PMC6112137 DOI: 10.1186/s12886-018-0888-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 08/17/2018] [Indexed: 01/10/2023] Open
Abstract
Background To evaluate the safety, efficacy, and the refractive outcomes of single-step transepithelial photorefractive keratectomy (TransPRK) for the correction of mild, moderate, and high myopia. Methods This study consecutively recruited 32 high myopic eyes, 32 mild myopic and 32 moderate myopic eyes. Eyes with myopia that had undergone TransPRK treatment. Pre- and post-operative visual and refractive data, corneal Higher Order Aberration (HOA) as well as safety and efficacy indices were analyzed at 6 months postoperatively. Results Six months after TransPRK, the manifest refraction spherical equivalent (SE) was not significantly between high myopia group and moderate myopia group (p = 0.636). No eyes lost ≥2 lines of corrected distant visual acuity (CDVA) in high myopic eyes. The uncorrected distance visual acuity (UDVA) was significantly higher in low and moderate myopia groups than the high myopia group (P < 0.001; P = 0.002). The CDVA was not significantly different between moderate and high myopia groups (P = 0.057). There was no significant difference in mean safety index between high myopia group (1.01 ± 0.14) and mild myopia group (1.08 ± 0.15) (P > 0.05). The mean safety index was significantly higher in the moderate myopia group (1.16 ± 0.23) than in the high myopia group (1.01 ± 0.14) (P = 0.002). The efficacy index was significantly higher in the moderate myopia group (1.05 ± 0.20) than in the high myopia group (0.89 ± 0.17) (P = 0.02), and there was no significant difference between the high myopia group (0.89 ± 0.17) and the low myopia group (0.96 ± 0.16) (P = 0.14). Conclusions The mean safety index was over 1.0 in the three groups. TransPRK showed acceptable safety and efficacy in the moderate myopic eyes, as well as mild and high myopic eyes. High myopic eyes got very similar refractive results with moderate myopic eyes six months postoperatively. The safety and efficacy indexes were not significantly different between the high myopia group and the low myopia group.
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Affiliation(s)
- Lei Xi
- Department of Ophthalmology, Peking University International Hospital, Beijing, China
| | - Chen Zhang
- Tianjin Medical University Eye hospital, Tianjin Medical University Eye Institute, School of Optometry and Ophthalmology, Tianjin, China
| | - Yanling He
- Department of Ophthalmology, Peking University People's Hospital, Xizhimen South Street 11, Xi Cheng District, Beijing, 100044, China.
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