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Efficacy of single-step transepithelial photorefractive keratectomy in myopia, hyperopia and astigmatism-a systematic review

BMC Ophthalmology volume 25, Article number: 93 (2025) Cite this article

Abstract

Background

This systematic review assesses the efficacy of single-step transepithelial photorefractive keratectomy (tPRK) in terms of postoperative pain, epithelial healing, postoperative haze and visual acuity. It also compares single tPRK to two-step tPRK where data is available.

Methods

This systematic review adhered to the PRISMA reporting guidelines (Preferred Reporting Items for Systematic Reviews and Meta-analyses). An electronic literature search was conducted on PUBMED, Scopus, and Google Scholar. The quality of the studies included in this systematic review was evaluated using the Newcastle Ottawa Scale (NOS). The protocol of this systematic review was registered on PROSPERO with ID CRD42024494717.

Results

A total of 11 studies published between 2013 and 2023 were included in this systematic review. Studies revealed a significant improvement in visual acuity with both single-step tPRK and two-step tPRK. Two studies showed that single-step tPRK not only offers a better UDVA but also a significant improvement in the manifest sphere, cylinder, and spherical equivalent at various follow-up periods compared to two-step tPRK. One study demonstrated the broad effectiveness of single-step tPRK for myopia correction across low-, moderate-, and high-severity groups. Rapid epithelial healing was a consistent finding. Complete epithelial healing within 72 h was noted in 100% of eyes treated with single-step tPRK in one of the studies. The incidence of corneal haze following tPRK was generally low across the studies. Post-tPRK pain scores were initially lower in the single-step tPRK group. One study reported that the maximum pain level within the first four days after surgery was significantly lower in the single-step tPRK group than in the two-step tPRK group.

Conclusion

Both two-step and single-step tPRK are safe refractive procedures. Single-step tPRK, because of less haze formation, lower pain scores, faster healing, and greater effectiveness in improving visual acuity, is superior to the two-step technique.

Trial registration

The protocol of this systematic review was registered on PROSPERO with ID CRD42024494717.

Peer Review reports

Background

Refractive errors are the world’s most prevalent vision problem, affecting individuals of all ages [1]. These encompass conditions such as myopia (near-sightedness), hyperopia (farsightedness), and astigmatism (distorted vision at any distance) that significantly impact quality of life and can contribute to visual impairment [1,2,3]. A recent report indicated that refractive errors are the primary cause of moderate to severe vision impairment worldwide, affecting 157 million people [4]. Moreover, uncorrected refractive errors are the second leading cause of blindness, impacting 3.7 million individuals worldwide [4].

Fortunately, various corrective options exist for refractive errors. These include eyeglasses, contact lenses, and refractive surgeries such as Laser-assisted in situ keratomileusis (LASIK), Photorefractive keratectomy (PRK), small incision lenticule extraction (SMILE), Phakic intraocular lenses, and Refractive lens exchange (RLE) [4,5,6,7,8,9,10].

LASIK and SMILE are popular laser vision correction procedures that offer fast recovery and good results [11]. LASIK creates a corneal flap before reshaping the cornea and carries flap-related risks [11, 12]. SMILE has no flap-related complications, but it has limitations in terms of the types of refractive error that can be corrected and the higher cost compared to LASIK and PRK [11, 12]. In RLE, the natural lens is replaced with an implant, which is ideal for treating presbyopia but is more invasive and expensive [7]. Conventional PRK has served as a time-tested procedure for correcting refractive errors, particularly for hyperopia, patients with thinner corneas, and those who are in combat sports but have a slower healing time, prolonged visual recovery, limbal cell toxicity (with alcohol use) and an increased risk of haze formation [4,5,6]. In response to these limitations, transepithelial photorefractive keratectomy (tPRK) has emerged as a cutting-edge and promising technique for correcting refractive errors with minimal side effects. tPRK can be carried out as two-step or one-step approach [13, 14].

In contrast to the conventional PRK technique, tPRK technique removes the corneal epithelium using a laser [14, 15]. This approach aims to achieve faster visual recovery, reduce pain, improve epithelial healing, and lower haze formation. However, the two-step approach carries the risk of unintended hyperopic shifts, requiring adjustments to the ablation profile to prevent under- or overcorrection [14, 15]. Whereas, the one-step tPRK represents a groundbreaking innovation. It combines epithelial removal and stromal ablation into a single, laser-driven step. This potentially offers numerous advantages over both conventional and two-step tPRK procedures [14, 16]. One-step tPRK is effective and predictable for the correction of myopia, hypermetropia and myopic astigmatism, with minimal impact on corneal biomechanics compared to other refractive surgeries [14, 16,17,18,19].

This systematic review aimed to comprehensively assess the use of single-step tPRK for correcting refractive errors. We will analyse evidence from studies employing this method exclusively and compare it with evidence from studies utilizing the two-step tPRK approach. This evaluation will provide valuable insights to guide both surgeons and patients in making informed decisions about the most suitable refractive procedure, with the goal of improving visual health and quality of life for individuals with these common yet impactful conditions.

Methods

Protocol and registration

This systematic review adhered to the PRISMA reporting guidelines (Preferred Reporting Items for Systematic Reviews and Meta-analyses) [20]. The protocol of this systematic review was registered on PROSPERO with ID CRD42024494717.

Search strategy

An electronic literature search was conducted on PUBMED, Scopus, and Google Scholar. The literature search was limited to articles published between 2013 and 2023 and to the English language. Two reviewers, X and Y independently searched the articles using Boolean operators. The search strategy included medical subject headings (MESHs) and keywords such as Streamlight Trans-PRK, single-step transepithelial photorefractive keratectomy, two-step photorefractive keratectomy, refractive errors, myopia, hypermetropia, astigmatism, postoperative pain, UCVA, CDVA, BCVA, epithelial healing, and haze. Disagreements between the reviewers were resolved by consulting a third reviewer, Z.

Inclusion and exclusion criteria

Inclusion

The eligibility criteria were based on the PICO question, i.e., Population: Patients aged > 18 years and of any sex who were diagnosed with refractive myopia, hyperopia or astigmatism; Intervention: Single-step transepithelial photorefractive keratectomy; Control: Two-step photorefractive keratectomy; Outcomes: Primary outcome: visual acuity; and Secondary outcomes: Postoperative pain, epithelial healing, and haze. The types of studies included were nonrandomized control trials (cohort or case‒control studies), randomized control trials, and case series.

Exclusion

Publications such as review articles or meta-analyses, editorials, conference papers, gray literature, books, case reports, guidelines, and qualitative studies were excluded.

Quality assessment of studies

The evaluation of study quality in this systematic review was conducted using the Newcastle Ottawa Scale (NOS) [21, 22], which assesses three main criteria: selection (encompassing four elements), comparability (one element), and outcome or exposure (three elements). Each study received a star for each NOS criterion it met. An additional star was awarded for studies that controlled for extra factors in the Comparability category, allowing a maximum of two stars in this dimension. The aggregate of these stars determined the study’s overall quality: 7 to 9 stars denoted high quality, 4 to 6 stars indicated moderate quality, and fewer than 4 stars suggested poor quality. Reviewer Z initially appraised the studies, with Reviewer X validating these assessments. Disagreements between the reviewers were resolved by consulting a third reviewer, Y.

Study selection and data extraction

The search results on PubMed, Scopus and Google Scholar were imported into Endnote software (version 11). Initially, 79 articles were identified through searches in databases such as Google Scholar, PubMed, and Scopus. After removing duplicates and screening titles and abstracts, a more focused group of articles underwent full-text review for eligibility based on predefined criteria. Thus, only 11 articles that met the inclusion criteria were included (Fig. 1).

Data was extracted from the included articles by the Z reviewer. The extracted data included the name of the author, year of publication, country, study design, treatment type, sample size, age, sex, follow-up time, UDVA, manifest sphere, manifest cylinder, MRSE, and outcomes with p values (if available). The data was collected on an MS Excel spreadsheet.

Fig. 1
figure 1

PRISMA flowchart for article selection

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Results

A total of 11 studies published between 2013 and 2023 were included in this systematic review. The included studies were case series, interventional studies, randomized controlled trials, and observational studies from countries such as Romania, Egypt, France, Germany, Turkey, China, and Iran. Seven studies were prospective, and four studies were retrospective. The sample sizes range from 25 to 250 patients to larger cohorts, such as the one in Lin et al. [23] with 2093 eyes. Other details of the included studies are given in Table 1.

Table 2 shows the outcomes of patients who underwent single-step tPRK and two-step tPRK for myopia and astigmatism correction. Studies revealed a significant improvement in visual acuity with both single-step tPRK and two-step tPRK. Specifically, in the studies by Abdel-Radi et al. [13] and Giral et al. [24] demonstrated that single-step tPRK not only offers a better UDVA but also a significant improvement in the manifest sphere, cylinder, and spherical equivalent at various follow-up periods compared to two-step tPRK. Gaeckle et al. observed similar positive outcomes in both single-step and two-step tPRK groups, with patients in both achieving an uncorrected UDVA of 1.0 or better [25]. Moreover, Xi et al. demonstrated the broad effectiveness of single-step tPRK for myopia correction across low-, moderate-, and high-severity groups. They reported significant improvements in the sphere, cylinder, and both UDVA and CDVA over a six-month follow-up period after single-step tPRK [26].

Table 3 highlights the safety profile of tPRK, which has minimal complications such as haze, low postoperative pain levels, and efficient epithelial healing. The incidence of corneal haze following tPRK was generally low across the studies. Sima et al. observed grade 0.5 haze in only two patients, which resolved with topical corticosteroids by the 3-month visit [27]. Abdel-Radi et al. noted grade 0 haze at 6 months in most eyes across different treatment groups [13]. Giral et al. and Abdelwahab et al. both reported reductions in haze over time, with no haze observed at 6 months in the former and minor, non-visually significant haze in the latter that resolved by the end of one year [24, 28]. Beser et al. reported that most eyes showed no corneal haze one year post operation, with a small percentage displaying clinically insignificant haze [29]. Post-tPRK pain scores were initially lower in the single-step tPRK group but plateaued by the 7th day according to Abdel-Radi [13]. Gaeckle et al. reported that the maximum pain level within the first four days after surgery was significantly lower in the single-step tPRK group than in the two-step tPRK group [25]. Adib-Moghaddam et al. reported mild intraoperative pain in a few patients, with a mean postoperative pain score of 1.2 [30]. Rapid epithelial healing was a consistent finding, with Abdel-Radi et al. and Abdelwahab et al. highlighting significantly faster healing times in the single-step tPRK groups [13, 28]. Complete epithelial healing within 72 h was noted in 100% of eyes treated with single-step tPRK in the study by Adib-Moghaddam et al. [30].

Table 4 shows the quality assessment of the included studies. A score of 9 stars indicates the highest quality according to the NOS criteria, reflecting robust study design, high comparability between groups, and comprehensive outcome assessment. Articles with lower scores primarily lost points in the Comparability category (N/A = not applicable), suggesting a lack of or insufficient comparison groups within the study design.

Studies by Sima et al. [27] and Abdel-Radi et al. [13] scored the highest, with a perfect 9/9. This indicates that these studies comprehensively met the criteria across selection, comparability, and outcome categories, demonstrating robust methodology, thorough outcome assessment, and effective comparability between groups. Gaeckle et al. [25] One study scored 8 out of 9, nearly reaching the highest score, with minor deductions again likely due to comparability issues. AbdelRadi et al. [31] One study scored 7 out of 9, reflecting a good methodological approach but with room for improvement in the Comparability category. The studies by Giral et al. [24], Abdelwahab et al. [28], Beser et al. [29], Lin et al. [23], Xi et al. [32], Xi et al. [26] and Adib-Moghaddam et al. [30] scored lower, each achieving a score of 6 out of 9. The primary reason for the lower scores was the lack of comparability due to the absence of a comparison group.

Table 1 Baseline characteristics of the included studies (n = 11)
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Table 2 Visual acuity and refractive outcomes following single-step and two-step tPRK (n = 11)
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Table 3 Epithelial healing, corneal hazing, and pain following single-step and two-step TPRK (n = 11)
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Table 4 Quality assessment of the included studies (n = 11)
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Discussion

PRK is a well-established laser refractive surgery for the correction of myopia, hypermetropia and astigmatism [33, 34]. The advent of tPRK has introduced a variation of the conventional technique, which promises a more comfortable postoperative experience and faster visual recovery [26, 28, 30, 31, 35,36,37,38]. It has demonstrated high efficacy and safety for correcting myopia and astigmatism, and improving refraction and hence quality of vision [30]. Another key advantage of single-step tPRK is faster healing of the corneal epithelium (outer layer). This layer is crucial for protecting the eye and maintaining clear vision. It therefore also has less postoperative pain than conventional tPRK [19, 25, 29, 39, 40].

In this systematic review, both single-step and two-step tPRK demonstrated significant improvements in visual acuity for myopia and astigmatism correction. However, studies by Abdel-Radi et al. and Giral et al. suggest that single-step tPRK might offer a slight edge, achieving better UDVA and showing a sphere, cylinder, and spherical equivalent compared to the two-step approach at various follow-up periods [13, 24]. Furthermore, studies have consistently reported faster epithelial healing in the single-step group than in the two-step group [13, 16, 24, 25, 28, 30]. This quicker healing translates to a shorter period of vulnerability to infection and discomfort after surgery [25, 41]. We also found that single-step tPRK appears to be safe and well tolerated. The incidence of corneal haze following tPRK was generally low across the studies [13, 24, 25, 27, 28, 30, 31]. Additionally, postoperative pain scores were lower with single-step tPRK, especially in the initial days after surgery [13, 25, 28, 30].

Evidence focusing specifically on tPRK and PRK for hyperopia and hyperopic astigmatism remains limited. Available data suggest that high hyperopic corrections are associated with a higher risk of adverse outcomes. While Adib-Moghaddam et al. reported no eye lost two or more lines of preoperative CDVA loss in their cohort of hyperopic patients​ [42]. O’Brart et al. found that 8% of eyes lost two lines of Snellen BCVA, attributed primarily to cataract formation rather than PRK in hyperopic patients​.​ [43] Abdel-Radi et al. observed no significant haze in most eyes after single-step tPRK for hyperopia, demonstrating the effectiveness of mitomycin C in reducing haze formation​ [31]. In contrast, O’Brart et al. found residual peripheral corneal haze in 25% of eyes at 7.5 years postoperatively, particularly at higher corrections [43]. These findings suggest that with optimized postoperative protocols, including the use of mitomycin C, the safety profile of tPRK for hyperopia may be comparable to its application in myopia and astigmatism. However, the predictability and refractive stability of hyperopic PRK remain challenging at higher correction levels.

Previous reviews have documented the efficacy and safety of conventional PRK and two-step tPRK, providing a foundation for understanding the evolution of refractive surgery techniques [9, 35, 39]. Our findings align with these earlier reports in terms of efficacy and safety but further suggest that the single-step approach might offer additional benefits in terms of reduced postoperative pain, faster visual recovery, and potentially lower haze rates, echoing advancements in laser technology and procedural efficiency.

This systematic review rigorously assessed the quality of the included studies using established criteria for evaluating the methodological soundness and risk of bias. Quality assessment tools such as the NOS for observational studies and RCTs are employed to systematically appraise the internal validity and overall reliability of the evidence [21, 22, 44]. By critically appraising the study design, sample size, patient selection criteria, outcome measures, and follow-up durations, the review ensures that only high-quality studies with robust methodologies are included in the synthesis. This approach enhances the credibility and validity of the review findings, enabling clinicians and researchers to make well-informed decisions based on the available evidence. This review has several strengths. This study adhered to the PRISMA guidelines, ensuring a systematic and comprehensive search strategy. The analysis included a variety of study designs, providing a broader perspective on the current evidence. Additionally, we compared single-step tPRK with the two-step approach, offering valuable insights for surgeons and patients considering refractive surgery options. However, limitations are also present. The review included a moderate number of studies, with some lacking comparison groups, potentially impacting the generalizability of the findings. Furthermore, the evidence for tPRK in hyperopia and hyperopic astigmatism is limited, with a higher incidence of haze and refractive regression compared to myopia. Long-term data on safety and efficacy beyond one year are also scarce. Future research with larger sample sizes, longer follow-up periods, and robust study designs is warranted to further solidify the evidence base for single-step tPRK. Hence, this review can inform ophthalmologists and patients by providing valuable insights into the potential benefits of single-step tPRK. By understanding the current evidence on its efficacy and safety profile, patients can make more informed decisions regarding refractive surgery options, while ophthalmologists can stay updated on the latest advancements in laser vision correction techniques.

Conclusion

Both two-step and single-step tPRK are safe refractive procedures. Single step tPRK, because of less haze formation, lower pain scores, faster healing, and greater effectiveness in improving visual acuity, is superior to the two-step technique.

Data availability

Data used in the analyses can be found in the published article, which were listed in the references of this manuscript.

References

  1. Schiefer U, Kraus C, Baumbach P, Ungewiß J, Michels R. Refractive errors. Dtsch Arztebl Int. 2016;113(41):693–702. https://doiorg.publicaciones.saludcastillayleon.es/10.3238/arztebl.2016.0693.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Khoshhal F, Hashemi H, Hooshmand E, Saatchi M, Yekta A, Aghamirsalim M, et al. The prevalence of refractive errors in the Middle East: a systematic review and meta-analysis. Int Ophthalmol. 2020;40:1571–86.

    Article  PubMed  Google Scholar 

  3. McCormick I, Mactaggart I, Bastawrous A, Burton MJ, Ramke J. Effective refractive error coverage: an eye health indicator to measure progress towards universal health coverage. Ophthalmic Physiological Opt. 2020;40(1):1.

    Article  Google Scholar 

  4. Bourne RRA, Cicinelli MV, Sedighi T, Tapply IH, McCormick I, Jonas JB, et al. Effective refractive error coverage in adults aged 50 years and older: estimates from population-based surveys in 61 countries. Lancet Glob Health. 2022;10(12):e1754–63. https://doiorg.publicaciones.saludcastillayleon.es/10.1016/s2214-109x(22)00433-8.

    Article  CAS  PubMed  Google Scholar 

  5. Kim TI, Del Alió JL, Wilkins M, Cochener B, Ang M. Refractive surgery. Lancet. 2019;393(10185):2085–98. https://doiorg.publicaciones.saludcastillayleon.es/10.1016/s0140-6736(18)33209-4.

    Article  PubMed  Google Scholar 

  6. Li SM, Kang MT, Wang NL, Abariga SA. Wavefront excimer laser refractive surgery for adults with refractive errors. Cochrane Database Syst Rev. 2020;12(12):Cd012687. https://doiorg.publicaciones.saludcastillayleon.es/10.1002/14651858.CD012687.pub2.

    Article  PubMed  Google Scholar 

  7. Alio JL, Grzybowski A, El Aswad A, Romaniuk D. Refractive lens exchange. Surv Ophthalmol. 2014;59(6):579–98.

    Article  PubMed  Google Scholar 

  8. Liu T, Shafer BM, Thompson V. Update on refractive surgery. Adv Ophthalmol Optometry. 2021;6:325–39.

    Article  Google Scholar 

  9. Moshirfar M, Santos JM, Wang Q, Stoakes IM, Porter KB, Theis JS et al. A literature review of the incidence, management, and prognosis of corneal epithelial-related complications after laser-assisted in situ keratomileusis (LASIK), Photorefractive Keratectomy (PRK), and small incision Lenticule extraction (SMILE). Cureus. 2023;15(8).

  10. Wilson SE. Biology of keratorefractive surgery-PRK, PTK, LASIK, SMILE, inlays and other refractive procedures. Exp Eye Res. 2020;198:108136.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Hamilton DR, Chen AC, Khorrami R, Nutkiewicz M, Nejad M. Comparison of early visual outcomes after low-energy SMILE, high-energy SMILE, and LASIK for myopia and myopic astigmatism in the United States. J Cataract Refractive Surg. 2021;47(1):18–26.

    Article  Google Scholar 

  12. Shah R. History and results; indications and contraindications of SMILE, compared with LASIK. Asia-Pacific J Ophthalmol. 2019;8(5):371–6.

    Article  Google Scholar 

  13. 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(8):1545–52. https://doiorg.publicaciones.saludcastillayleon.es/10.1038/s41433-022-02174-4.

    Article  PubMed  Google Scholar 

  14. Antonios R, Fattah MA, Mosquera SA, Abiad BH, Sleiman K, Awwad ST. Single-step transepithelial versus alcohol-assisted photorefractive keratectomy in the treatment of high myopia: a comparative evaluation over 12 months. Br J Ophthalmol. 2017;101(8):1106–12.

    Article  PubMed  Google Scholar 

  15. Tangmonkongvoragul C, Supalaset S, Tananuvat N, Ausayakhun S. Two-step transepithelial photorefractive keratectomy with wavelight EX500 platform for adolescents and adults with low to moderate myopia: a 12-month comparative evaluation. Clin Ophthalmol. 2021;15:4109–4119. https://doiorg.publicaciones.saludcastillayleon.es/10.2147/OPTH.S336727.

  16. Adib-Moghaddam S, Soleyman-Jahi S, Adili-Aghdam F, Mosquera SA, Hoorshad N, Tofighi S. Single-step transepithelial photorefractive keratectomy in high myopia: qualitative and quantitative visual functions. Int J Ophthalmol. 2017;10(3):445.

    PubMed  PubMed Central  Google Scholar 

  17. Hasani H, Maskan M. Comparison of conventional versus trans-epithelial photorefractive keratectomy in hyperopia treatment: a contralateral study. J Iran Med Council. 2023;6(4):703–11. https://doiorg.publicaciones.saludcastillayleon.es/10.18502/jimc.v6i4.13451.

  18. Pertiwi ANS, Mahayana IT, Supartoto A, Goenawan W. Transepithelial photorefractive keratectomy for myopia: effect of age and keratometric values. Int J Ophthalmol. 2021;14(5):744.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Zhang Y, Li T, Li Z, Dai M, Wang Q, Xu C. Clinical outcomes of single-step transepithelial photorefractive keratectomy and off-flap epipolis-laser in situ keratomileusis in moderate to high myopia: 12-month follow-up. BMC Ophthalmol. 2022;22(1):234.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71. https://doiorg.publicaciones.saludcastillayleon.es/10.1136/bmj.n71.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Lo CK-L, Mertz D, Loeb M. Newcastle-Ottawa Scale: comparing reviewers’ to authors’ assessments. BMC Med Res Methodol. 2014;14:1–5.

    Article  Google Scholar 

  22. Wells GA, Shea B, O’Connell D, Peterson J, Welch V, Losos M et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. 2000.

  23. Lin DTC, Holland SP, Verma S, Hogden J, Arba-Mosquera S. Immediate and short term visual recovery after SmartSurf(ACE) photorefractive keratectomy. J Optom. 2019;12(4):240–7. https://doiorg.publicaciones.saludcastillayleon.es/10.1016/j.optom.2019.04.003.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Giral JB, Bloch F, Sot M, Zevering Y, El Nar A, Vermion JC, et al. Efficacy and safety of single-step transepithelial photorefractive keratectomy with the all-surface laser ablation SCHWIND platform without mitomycin-C for high myopia: a retrospective study of 69 eyes. PLoS ONE. 2021;16(12):e0259993. https://doiorg.publicaciones.saludcastillayleon.es/10.1371/journal.pone.0259993.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Gaeckle HC. Early clinical outcomes and comparison between trans-PRK and PRK, regarding refractive outcome, wound healing, pain intensity and visual recovery time in a real-world setup. BMC Ophthalmol. 2021;21(1):181. https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12886-021-01941-3.

    Article  PubMed  PubMed Central  Google Scholar 

  26. 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(1):209. https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12886-018-0888-x.

    Article  PubMed  PubMed Central  Google Scholar 

  27. SIMA G, MOCANU V, TATARU PREDAA, PAC C. CP, MUNTEANU M. EFFECT OF MITOMYCIN C 0.02% ON ENDOTHELIAL CELLS DURING STREAMLIGHT TransPRK FOR PATIENTS WITH LOWMODERATE MYOPIA/ASTIGMATISM. Farmacia. 2023;71(4).

  28. Abdelwahab SM, Salem MH, Elfayoumi MA. Single-step transepithelial photorefractive keratectomy in low to moderate myopia: a one-year follow-up study. Clin Ophthalmol. 2021;15:3305–3313. https://doiorg.publicaciones.saludcastillayleon.es/10.2147/OPTH.S326048.

  29. 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(12):2940–4. https://doiorg.publicaciones.saludcastillayleon.es/10.4103/ijo.IJO_279_20.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Adib-Moghaddam S, Soleyman-Jahi S, Salmanian B, Omidvari A-H, Adili-Aghdam F, Noorizadeh F, et al. Single-step transepithelial photorefractive keratectomy in myopia and astigmatism: 18-month follow-up. J Cataract Refractive Surg. 2016;42(11):1570–8.

    Article  Google Scholar 

  31. Abdel-Radi M, Rateb M, Saleh MG, Aly MOM. Twelve-month outcomes of single-step transepithelial photorefractive keratectomy for moderate hyperopia and hyperopic astigmatism. Eye Vis. 2023;10(1):7.

    Article  Google Scholar 

  32. Xi L, Zhang C, He Y. Clinical outcomes of transepithelial photorefractive keratectomy to treat low to moderate myopic astigmatism. BMC Ophthalmol. 2018;18(1):115. https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12886-018-0775-5.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Somani SN, Moshirfar M, Patel BC, Photorefractive Keratectomy. [Updated 2023 Jul 18]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK549887/

  34. Shortt AJ, Allan BD. Photorefractive keratectomy (PRK) versus laser-assisted in-situ keratomileusis (LASIK) for myopia. Cochrane Database Syst Rev. 2006;2Cd005135. https://doiorg.publicaciones.saludcastillayleon.es/10.1002/14651858.CD005135.pub2.

  35. Alasbali T. Transepithelial Photorefractive Keratectomy Compared to Conventional Photorefractive Keratectomy: a Meta-analysis. J Ophthalmol. 2022;2022:3022672. https://doiorg.publicaciones.saludcastillayleon.es/10.1155/2022/3022672.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Bakhsh AM, Elwan SAM, Chaudhry AA, El-Atris TM, Al-Howish TM. Comparison between Transepithelial Photorefractive Keratectomy versus Alcohol-assisted Photorefractive Keratectomy in correction of myopia and myopic astigmatism. J Ophthalmol. 2018;2018:5376235. https://doiorg.publicaciones.saludcastillayleon.es/10.1155/2018/5376235.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Naderi M, Jadidi K, Mosavi SA, Daneshi SA. Transepithelial Photorefractive Keratectomy for low to moderate myopia in comparison with conventional photorefractive Keratectomy. J Ophthalmic Vis Res. 2016;11(4):358–62. https://doiorg.publicaciones.saludcastillayleon.es/10.4103/2008-322x.194070.

    Article  PubMed  PubMed Central  Google Scholar 

  38. 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(1):68. https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12886-022-02293-2.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Tomás-Juan J, Murueta-Goyena Larrañaga A, Hanneken L. Corneal regeneration after Photorefractive Keratectomy: a review. J Optom. 2015;8(3):149–69. https://doiorg.publicaciones.saludcastillayleon.es/10.1016/j.optom.2014.09.001.

    Article  PubMed  Google Scholar 

  40. Alhawsawi A, Hariri J, Aljindan M, Alburayk K, Alotaibi HA. Outcomes of single-step Transepithelial Photorefractive Keratectomy compared with alcohol-assisted Photorefractive Keratectomy using Wave-Light EX500 platform. Cureus. 2023;15(3):e36872. https://doiorg.publicaciones.saludcastillayleon.es/10.7759/cureus.36872.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Zhuang S, Jhanji V, Sun L, Li J, Jiang J, Zhang R. Infectious keratitis after transepithelial photorefractive keratectomy: a case report. Indian J Ophthalmol. 2020;68(12):3043–5. https://doiorg.publicaciones.saludcastillayleon.es/10.4103/ijo.IJO_1730_20.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Adib-Moghaddam S, Arba-Mosquera S, Walter-Fincke R, Soleyman-Jahi S, Adili-Aghdam F. Transepithelial Photorefractive Keratectomy for Hyperopia: a 12-Month Bicentral Study. J Refract Surg. 2016;32(3):172–80. https://doiorg.publicaciones.saludcastillayleon.es/10.3928/1081597x-20160121-01.

    Article  PubMed  Google Scholar 

  43. O’Brart DP, Patsoura E, Jaycock P, Rajan M, Marshall J. Excimer laser photorefractive keratectomy for hyperopia: 7.5-year follow-up. J Cataract Refract Surg. 2005;31(6):1104–13. https://doiorg.publicaciones.saludcastillayleon.es/10.1016/j.jcrs.2004.10.051.

    Article  PubMed  Google Scholar 

  44. Luchini C, Veronese N, Nottegar A, Shin JI, Gentile G, Granziol U, et al. Assessing the quality of studies in meta-research: Review/guidelines on the most important quality assessment tools. Pharm Stat. 2021;20(1):185–95.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Ophthalmology and Visual Sciences, Aga Khan Univesity Hospital, Karachi, Pakistan

    Sharmeen Akram, Wardah Moazzum & Khadijah Abid

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  1. Sharmeen Akram
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  2. Wardah Moazzum
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Contributions

Conceptualization: SA, KA. Data curation: KA, SA, WM. Formal analysis: KA. Methodology: KA. Project administration: SA, KA. Supervision: SA, KA. Validation: WM. Visualization: WM. Writing -original draft: KA. Writing-review & editing: SA, KA, WM. All authors reviewed the manuscript.

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Correspondence to Khadijah Abid.

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Akram, S., Moazzum, W. & Abid, K. Efficacy of single-step transepithelial photorefractive keratectomy in myopia, hyperopia and astigmatism-a systematic review. BMC Ophthalmol 25, 93 (2025). https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12886-024-03830-x

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BMC Ophthalmology

ISSN: 1471-2415

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