Comparison of Preoperative Refractive Status and Postoperative Recovery Outcomes Following Transepithelial Photorefractive Keratectomy

Introduction: Transepithelial photorefractive keratectomy (Trans-PRK) offers superior re-epithelialization and visual recovery. This study evaluates the impact of preoperative refractive status on clinical outcomes and identifies prognostic factors across varying myopic severities. Methods: This retrospective observational study included 125 eyes [64 patients; age > 20 years; best-corrected visual acuity (BCVA) ≥ 20/25] that underwent Trans-PRK between March and December 2022. Patients were stratified into low myopia (LM: > -5.0 D), moderate-to-high myopia (MHM: ≤ -5.0 D to > -8.0 D) extremely high myopia (EHM: ≤ -8.0 D) groups. Analysis focused on preoperative refraction, intraoperative parameters, postoperative uncorrected visual acuity (UCVA) and corneal conditions of superficial punctate keratitis (SPKs) and haze. Results: The mean age was 30.20 ± 6.34 years, with a mean initial manifest sphere (MS) of -6.42 ± 2.27 Diopter (D) overall and -3.73 ± 0.15 D, -6.28 ± 0.13 D and -9.17 ± 0.15 D in the LM, MHM and EHM groups, respectively. At a mean follow-up of 6.69 ± 3.73 months, the overall mean final manifest spherical equivalent (MSE) was -0.12 ± 0.73 D and mean final UCVA was 0.01 [Snellen equivalent (SE), 205/200] ± 0.08 logMAR. Predictability was 94.4%, 88.88% and 94.3% for the final MS ≤ -1.0 D, final MSE ≤ -1.0 D and UCVA ≥ 0.8, respectively. In the LM and MHM groups, cycloplegic and subjective refractions showed the highest concordance with emmetropia, whereas initial manifest refractions were most accurate for the EHM group. Corneal SPK incidence declined from 32.2% (1 month) to 1.6% (6 months), primarily localized to EHM eyes. Corneal haze peaked at 28.2% at three months before receding to 9.4% by 6 months. Conclusions: Refractive and visual stability were achieved by the third month for the LM and MHM groups, whereas the EHM group required six months to reach both refractive and visual plateaus. Despite transiently higher rates of corneal SPKs and haze in EHM eyes, final visual outcomes remained excellent (UCVA 18/20).