Real-world Comparison of StreamLightTM trans-PRK and Conventional PRK With Regard to Refractive Outcome, Wound Healing, Pain Intensity and Visual Recovery Time

Abstract

PurposeTo compare clinical outcomes of single-step transepithelial photorefractive keratectomy (tPRK) and conventional photorefractive keratectomy (PRK) regarding refractive outcome, visual acuity, wound healing, pain intensity and visual recovery time.MethodsIn this prospective clinical observational study 200 eyes of 100 consecutive patients with mild to moderate myopia with or without mild astigmatism were included. One hundred eyes each were treated with StreamLightTM tPRK or conventional PRK with the WaveLight® EX500 excimer laser. Visual acuity (Decimal) was assessed preoperatively and at day 4, 7 and 6 weeks postoperatively. Wound healing (hours between surgery and complete epithelial closure) was monitored at the slit lamp. Subjective pain intensity level was evaluated by a numeric pain rating scale (0 – 15) at day 4.ResultsVisual recovery was significantly faster in the tPRK group. At days 4 and 7, the mean monocular UCDVA was significantly better in the tPRK group than in the PRK group (p < 0.001). Four days after surgery 72% of eyes in the tPRK group but no eye in the PRK had an UCDVA of 0.7 or better. At six weeks postoperatively, UCDVA of 1.0 or better was achieved in both groups. Complete epithelial wound closure was achieved significantly faster in the tPRK group (p < 0.0001) and maximum pain level within the first 4 days after surgery was significantly lower in the tPRK group (p < 0.0001). No patient had lost a line of BCDVA and no complications or adverse effects were observed.ConclusionBoth treatments offer a safe and effective correction of low to moderate myopia with and without astigmatism. However, StreamLightTM tPRK offers faster visual recovery and epithelial healing and is associated with less pain as compared to conventional PRK. It can therefore be considered a good treatment option for patients who refuse or are not eligible for Femto-LASIK, but at the same time demand a faster and more comfortable recovery time than conventional PRK can offer.