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Photorefractive keratectomy (PRK)

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Last updated: May 17th, 2022

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Summary of Evidence

Evidence

1. General

2. Comparison of refractive techniques

2.1. PRK vs LASIK

Systematic review

2012 Settas (Cochrane)

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2012
Systematic review

No robust, reliable conclusions could be reached, but the non-randomised trials reviewed appear to be in agreement that hyperopic-PRK and hyperopic-LASIK are of comparable efficacy.{Settas G, Settas C, Minos E, Yeung IY. Photorefractive keratectomy (PRK) versus laser assisted in situ keratomileusis (LASIK) for hyperopia correction. Cochrane Database Syst Rev. 2012 Jun 13;2012(6):CD007112. }

Inclusion of results of non-randomised trials comparing hyperopic-PRK with hyperopic-LASIK.

Settas (Cochrane)
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2.2. PRK vs LASEK

Systematic review

2016 Li et.al. (Cochrane)

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2016
Systematic review

Uncertainty surrounds differences in efficacy, accuracy, safety, and adverse effects between LASEK and PRK for eyes with low to moderate myopia.{Li SM, Zhan S, Li SY, Peng XX, Hu J, Law HA, Wang NL. Laser-assisted subepithelial keratectomy (LASEK) versus photorefractive keratectomy (PRK) for correction of myopia. Cochrane Database Syst Rev. 2016 Feb 22;2(2):CD009799.}

Inclusion of 11 RCTs with a total of 428 participants 18 years of age or older with low to moderate myopia

Li et.al. (Cochrane)
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3. Surgical techniques

3.1. Transepithelial PRK

Meta-analysis

2021 Sabau et.al.

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2021
Meta-analysis

TransPRK was highly effective, safe, and predictable in correcting myopia and/or astigmatism.{Sabau A, Daas L, Behkit A, Wagenpfeil S, Langenbucher A, Ardjomand N, Flockerzi E, Seitz B. Efficacy, safety, and predictability of transepithelial photorefractive keratectomy: meta-analysis. J Cataract Refract Surg. 2021 May 1;47(5):634-640.}

Inclusion of Sixteen studies with a total of 1924 treated eyes.

Sabau et.al.
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Review

2018 Adib-Moghaddam

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2018
Review

Review of efficacy and safety of transepithelial PRK. {Adib-Moghaddam S, Soleyman-Jahi S, Sanjari Moghaddam A, Hoorshad N, Tefagh G, Haydar AA, Razi-Khoshroshahi M, Arba Mosquera S. Efficacy and safety of transepithelial photorefractive keratectomy. J Cataract Refract Surg. 2018 Oct;44(10):1267-1279.}

Adib-Moghaddam
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cited by count

3.2. Intraoperative mitomycin-C

Clinical trial

2021 Lu et.al.

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2021
Clinical trial

With a temporary impact on corneal epithelial regeneration and refractive correction, intraoperative MMC application in transPRK decreased the haze incidence but had no effect on epithelial remodeling.{Lu NJ, Koppen C, Awwad S, Aslanides MI, Aslanides IM, Chen SH. Effect of intraoperative mitomycin-C application on epithelial regeneration after transepithelial photorefractive keratectomy. J Cataract Refract Surg. 2021 Feb 1;47(2):227-232.}

Lu et.al.
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4. Pain management

Review

2018 Golan and Randleman

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2018
Review

To date, the literature supports the use of topical agents such as nonsteroidal anti-inflammatory medications (NSAIDs) and diluted topical anesthetics in combination with oral agents such as opiates and NSAIDs for acute pain management. {Golan O, Randleman JB. Pain management after photorefractive keratectomy. Curr Opin Ophthalmol. 2018 Jul;29(4):306-312. }

Golan and Randleman
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Review

2013 Woreta et.al.

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2013
Review

Review of corneal pain pathways and current approaches to pain management after PRK.{Woreta FA, Gupta A, Hochstetler B, Bower KS. Management of post-photorefractive keratectomy pain. Surv Ophthalmol. 2013 Nov-Dec;58(6):529-35. }

Woreta et.al.
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4.1. Bandage contact lens

Clinical trial

2019 Shetty et.al.

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2019
Clinical trial

A bandage contact lens soaked in ketorolac 0.45% solution can act as a potential drug depot that can reduce pain after transepithelial PRK.{Shetty R, Dalal R, Nair AP, Khamar P, D’Souza S, Vaishnav R. Pain management after photorefractive keratectomy. J Cataract Refract Surg. 2019 Jul;45(7):972-976. }

Prospective case series of patients were divided into 2 groups of 35 eyes each. After transepithelial PRK, a regular soft bandage contact lens was placed in Group 1 and a ketorolac-soaked bandage contact lens was placed in Group 2.

Shetty et.al.
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4.2. Intracanalicular dexamethasone

Clinical trial

2021 Ibach et.al.

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2021
Clinical trial

In patients undergoing PRK, there was preference toward a dexamethasone insert in place of topical prednisolone acetate for the postoperative steroid treatment. There were no statistically or clinically significant differences between the two cohorts in regard to healing time or visual outcomes.{Ibach MJ, Shafer BM, Wallin DD, Puls-Boever KR, Thompson VM, Berdahl JP. The Effectiveness and Safety of Dextenza 0.4 mg for the Treatment of Postoperative Inflammation and Pain in Patients After Photorefractive Keratectomy: The RESTORE Trial. J Refract Surg. 2021 Sep;37(9):590-594.}

Ibach et.al.
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5. Complications

References

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