Pain, wound healing and refractive comparison of mechanical and transepithelial debridement in photorefractive keratectomy for myopia: Results of 1 year follow-up

Abstract

Purpose: To compare the efficacy, safety and postoperative pain of mechanical versus transepithelial photorefractive keratectomy (PRK) techniques. Setting: Cornea and refractive surgery subspecialty. Design: Prospective clinical trial. Methods: This prospective comparative study included 84 eyes of 42 patients with myopia who received mechanical PRK (m-PRK) in 1 eye and transepithelial PRK (t-PRK) in the contralateral eye. The mean patient age was 28.5 +/- 6.3 years (range 20-46 years). Postoperative uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), manifest refractions, postoperative epithelial healing time, surgical time, postoperative pain rating and corneal haze were recorded. Results: At week 1, statistically the UDVA was significantly better in the t-PRK eyes; however, at 3 months, similar refractive stability was achieved in both groups. The mean spherical equivalent (SE) decreased from -2.44 +/- 1.00 D (m-PRK eyes) and -2.88 +/- 1.24 D (t-PRK eyes) at baseline to -0.19 +/- 0.38 D and -0.30 +/- 040 D, respectively, after 1 year. Surgical time was 98.6 +/- 9.8 s in m-PRK eyes and 58.0 +/- 6.4 s in t-PRK eyes. On postoperative days 1 and 3, using the global assessment rating, 81% of mPRK eyes that had pain, reported more pain than that reported for the tPRK eyes. In addition, m-PRK treated eyes demonstrated higher mean pain scores based on the 11-point numerical rating scale and Visual Analogue Scale (VAS). The mean time to complete epithelial healing was 2.19 +/- 0.39 days (t-PRK) and 3.76 +/- 0.43 days (m-PRK). Conclusion: t-PRK for mild-to-moderate myopia was more comfortable than conventional m-PRK; patients had less pain, and faster healing time. (C) 2014 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.