Search Results (9)

This study analyzed the impact of corneal epithelial refraction on the correction of hyperopic and mixed astigmatism eyes treated with transepithelial photorefractive keratectomy. From the epithelial refraction provided by the diagnostic device, OCT correlations were evaluated with respect to manifest refraction. The postoperative outcomes showed a mean sphere of −0.03 D and a mean cylinder of −0.33 D, with 93% and 98% having 0.5 D, 1 D, or less spherical equivalent refractive error. The epithelium showed preoperative toricity: at 6 mm, the epithelium showed a compensational effect of ~15% for the refractive astigmatism, whereas at 3 mm, the compensation accounted for ~25% of the refractive astigmatism. No correlation was found between preoperative epithelial refraction and refractive deviation after hyperopic or mixed astigmatic transepithelial photorefractive treatment. This work provides insight into the refractive compensatory impact of the epithelium, suggests how one can benefit from that in transepithelial corrections, and sets a framework for the potential induction of errors in non-transepithelial corrections. Full article

Purpose: To evaluate the safety and efficacy of the transepithelial photorefractive keratectomy (TransPRK) performed using smart pulse technology (SPT) in myopic eyes with refractive error ranging from −5.25 D to −9.75 D. Methods: This retrospective study evaluated the outcomes of SPT-assisted TransPRK in 150 eyes performed using a 1050 Hz AMARIS excimer laser. Results: At 6 months postoperative, 98% of eyes achieved uncorrected distance visual acuity (UDVA) of 20/25 or better, and postoperative UDVA within one line of preoperative corrected distance visual acuity (CDVA). No eyes lost any line of CDVA. Residual spherical equivalent refraction and cylinder within ±0.50 D of intended correction were achieved in 72% and 67% of eyes, respectively. Ninety-seven percent of eyes reported no halos and glare. Conclusions: TransPRK using a 1050 Hz excimer laser with SPT showed excellent predictability, safety, and efficacy for moderate to high myopia correction. Full article

The type and nature of refractive surgery procedures has greatly increased over the past few decades, allowing for almost all patient populations to be treated to extremely high satisfaction. Conventional photorefractive keratectomy involves the removal of the corneal epithelium through mechanical debridement or dilute alcohol instillation. An improvement to this method utilises laser epithelial removal in a single-step process termed transepithelial photorefractive keratectomy (transPRK). We explore the history of transPRK from its early adoption as a two-step process, identify different transPRK platforms from major manufacturers, and describe the role of transPRK in the refractive surgery armamentarium. This is a narrative review of the literature. This review finds that TransPRK is a safe and effective procedure that works across a variety of patient populations. Though often not seen as a primary treatment option when compared to other corneal-based procedures that offer a faster and more comfortable recovery, there are many scenarios in which these procedures are not possible. These include, but are not limited to, cases of corneal instability, previous refractive surgery, or transplant where higher-order aberrations can impair vision in a manner not amenable to spectacle or contact lens correction. We discuss refinements to the procedure that would help improve outcomes, including optimising patient discomfort after surgery as well as reducing corneal haze and refractive regression. Full article

(1) Background: Laser-assisted refractive surgery is a safe and effective surgical correction of refractive error. For most patients, both the newer Trans-PRK and the established LASIK technique can produce the required surgical correction, sparking the question of which technique should be opted for. (2) Methods: The study prospectively evaluated 121 patients (230 eyes) for at least one month postoperatively; 66 patients (126 eyes) and 45 patients (85 eyes) returned for 6 months and 1 year follow-up. (3) Results: No statistical difference was recorded at 1 week or 1 month post-operation. At 6 months, a difference was found for spherical diopters (Trans-PRK −0.0476 ± 0.7012 versus FS-LASIK +0.425 ± 0.874, p = 0.004) and spherical equivalent (Trans-PRK −0.1994 ± 0.0294 versus FS-LASIK +0.225 ± 0.646, p = 0.025) but not for CYL D (Trans-PRK −0.3036 ± 0.5251 versus FS-LASIK −0.4 ± 0.820, p = 0.499). Uncorrected visual acuity was better for Trans-PRK 6 months post-operation (UCVA logMAR 0.02523 versus 0.0768 logMAR; p = 0.015 logMAR). At 1-year, Trans-PRK was favored for spherical diopters (Trans-PRK −0.0294 ± 0.6493 versus FS-LASIK +0.646 ± 0.909, p < 0.001) and spherical equivalent (Trans-PRK −0.218 ± 0.784 versus FS-LASIK 0.372 ± 1.08, p = 0.007). Overall speed in visual recovery, variance of results and surgically induced astigmatism were in favor of Trans-PRK. (4) Conclusions: The study reported improvements for Trans-PRK patients, with both techniques found to be safe and effective. Full article

(1) Introduction: We analysed epithelial changes after the treatment of moderate myopia with transepithelial photorefractive keratectomy. (2) Materials and Methods: We used optical coherence tomography data and analysed changes in the stroma and epithelium after ablation. We aimed to ascertain how much epithelium hyperplasia occurred after TransPRK; for this, we used data from 50 eyes treated with TransPRK with the AMARIS 1050 Hz, with a minimum follow-up of 4 months. (3) Results: The measured epithelial changes corresponded to a less than 0.1 ± 0.2D of spherical effect, less than 0.2 ± 0.2D of astigmatic effect, and less than 0.5 ± 0.2D of comatic effect. (4) Conclusions: The changes in epithelial thickness after aberration-neutral transepithelial photorefractive keratectomy for moderate myopia were very small, indicating a low level of epithelial hyperplasia without resembling a regression-inducing lentoid. Full article

Corneal epithelium removal during photorefractive keratotomy (PRK), TransPRK, or corneal cross-linking (CXL) means that patients experience pain and inflammation after the procedure, which need to be carefully managed with topical drug regimens. One highly effective class of topical analgesics is non-steroidal anti-inflammatory drugs (NSAIDs), but these must be used carefully, as their use has been associated with delayed re-epithelialization and, in rare cases, corneal melting. However, our clinical experience has been that the concomitant use of topical corticosteroids obviates this risk. Here, we present a mechanistic explanation for our observations, our TransPRK and epithelium-off CXL protocols, and the postoperative medication regimens where topical NSAIDs are used in combination with topical steroid therapy during the first two postoperative days (where pain and inflammation levels are the highest). We detail the results of a single-center retrospective case analysis that examined eyes that underwent TransPRK (n = 301) or epithelium-off CXL (n = 576). Topical NSAID use in the first two postoperative days to control pain and inflammation after PRK/TransPRK or epithelium-off CXL, when used in combination with topical steroid therapy, does not appear to be associated with corneal melting or delayed epithelial healing. This approach may represent an improvement over current methods of handling post-surgical pain in procedures that require corneal epithelial debridement. Full article

Transepithelial photorefractive keratectomy (TransPRK) is an established surface ablation technique used to correct refractive errors. Using anterior segment optical coherence (AS-OCT), it is now possible to measure the epithelium thickness and input these data into the laser platform. In this study, we explore whether better results were obtained in this way. To this end, we retrospectively analyze the results from a low-myopia group treated with a customized epithelium thickness, as measured using AS-OCT, and compare them with the results from a group treated with an optimized standard epithelium thickness. The customized epithelium profile group contains more eyes with vision better than 20/20, and more eyes in this group gain one line of corrected distance visual acuity (CDVA). In conclusion, with the customized epithelium thickness, we obtain superior results using TransPRK in low-myopia corrections. Full article

Is it possible to obtain good results in myopia of 2 or fewer diopters (D) with transepithelial photorefractive keratectomy (TransPRK) changing the optical zone and epithelium thickness? We retrospectively analyzed two groups of 296 eyes with a minimum follow-up of 4 months. Group A had 2 or less D, treated with an optical zone (OZ) 0.2 mm bigger than recommended, and a central epithelium thickness of 60 microns, and group B had 2 D to 5 D, with the recommended optical zone, and a 55-micron epithelium ablation at the center. The outcomes were not different between the two myopic ranges; the postop uncorrected distance visual acuity was 20/20 ± 4 in both groups (p = 0.2), which was −0.3 ± 0.8 lines worse than the preoperative corrected distance visual acuity in both groups (p = 0.5). The safety of the treatments resulted in a change of 0.0 ± 0.7 lines in the low myopia group, versus a gain of +0.1 ± 0.8 lines in the moderate myopia group (p = 0.1). The deviation from the intended target was −0.04 ± 0.33 D in the low myopia group and +0.07 ± 0.32 D in the moderate myopia group (p < 0.0001); the postoperative spherical equivalent was 0.00 ± 0.33 D in the low myopia group and +0.10 ± 0.31 D in the moderate myopia group (p < 0.0001). The postop refractive astigmatism was 0.32 ± 0.16 D in both groups (p = 0.5). In conclusion, the refractive and visual outcomes after TransPRK are comparable in low myopia changing the optical zone and epithelium thickness versus moderate myopia with standard optical zone and epithelium thickness. Full article

Purpose: We evaluated the refractive visual outcomes and efficacy of Transepithelial Photorefractive Keratectomy (TransPRK) using Smart Pulse Technology with static and dynamic cyclotorsion and the AMARIS 1050 Hz RS laser platform from Schwind in the eyes after a refractive lens exchange. Setting/Venue: Aurelios Augenlaserzentrum, Recklinghausen. Methods: We retrospectively evaluated the data of 552 consecutive eyes treated with refractive lens exchange between 2016 and 2019. A total of 47 eyes (8.5%) required a touch up after the clear lens exchange. From 43 eyes of 43 patients, we obtained a minimum follow up of 3 months. In all cases, we performed a TransPRK with a minimum optical zone of 7.2 mm, centering the ablation on the vertex of the cornea. Results: The average age of the treated eyes was 57 years old, with a range between 48 and 68 years. The mean treated sphere was 0.42 diopters (D), with a range between −1.0 and +1.75 D. The mean astigmatism was 1.06 D. Postoperatively, after laser vision correction, we reduced the sphere to a mean of 0.11 D (range −0.5 to +0.75 D), and, postoperatively, the mean astigmatism was 0.25 D (range −0.75 to 0 D). The predictability for a spheric equivalent (SEQ) of 0.5 D was 91%, and for 1 D it was 100% of the cases. No eye lost more than one Snellen line. Conclusions: TransPRK with smart pulse was predictable for correcting ametropia after Clear Lens Surgery. Full article