Long-term results of hyperopic ablations using alcohol-assisted PRK and FS-LASIK: comparative study.

PURPOSE: To evaluate the long-term visual and refractive outcomes of hyperopic excimer ablation using alcohol-assisted photorefractive keratectomy (PRK) and femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK). SETTING: American University of Beirut Medical Center, Beirut, Lebanon. DESIGN: Retrospective, matched comparative study. METHODS: Eyes that underwent alcohol-assisted PRK were compared to matched eyes that underwent FS-LASIK. All patients were followed up for at least 3 years after surgery. The refractive and visual outcomes of each group were compared at different postoperative time points. The main outcome measures were spherical equivalent deviation from target (SEDT), manifest refraction, and visual acuity. RESULTS: 83 eyes underwent alcohol-assisted PRK and 83 matched eyes underwent FS-LASIK. Preoperative manifest refraction spherical equivalent was 2.44 ± 1.18 diopters (D) and 2.20 ± 0.87 D ( P = .133) in the PRK and FS-LASIK groups, respectively. Preoperative manifest cylinder was -0.77 ± 0.89 D and -0.61 ± 0.59 D ( P = .175) for the PRK and LASIK groups, respectively. 3 years postoperatively, SEDT was 0.28 ± 0.66 D and 0.40 ± 0.56 D for the PRK and LASIK groups, respectively ( P = .222), whereas manifest cylinder was -0.55 ± 0.49 D and -0.30 ± 0.34 D for PRK and LASIK, respectively ( P < .001). The mean difference vector was 0.59 ± 0.46 for PRK and 0.38 ± 0.32 for LASIK ( P < .001). 13.3% of PRK eyes and 0% of LASIK eyes had >1 D of manifest cylinder ( P = .003). CONCLUSIONS: Both alcohol-assisted PRK and FS-LASIK are safe and effective for the treatment of hyperopia. PRK induces slightly more postoperative astigmatism than LASIK. Larger optical zones and recently introduced ablation profiles that lead to a smoother ablation surface might improve the clinical results of hyperopic PRK.

Epithelial Erosions and Refractive Results After Single-Step Transepithelial Photorefractive Keratectomy and Alcohol-Assisted Photorefractive Keratectomy in Myopic Eyes: A Comparative Evaluation Over 12 Months.

PURPOSE: To evaluate the epithelial erosion incidence and refractive results in myopic eyes undergoing single-step transepithelial photorefractive keratectomy (TransPRK) compared with alcohol-assisted photorefractive keratectomy (PRK). METHODS: This was a retrospective nonrandomized comparative study conducted at the American University of Beirut Medical Center. A total of 189 eyes that had undergone single-step transepithelial PRK (TransPRK) were compared with 189 matched eyes that had undergone alcohol-assisted PRK over a follow-up of 1 year. The incidence and symptoms of epithelial erosion were evaluated in both treatment groups using a post hoc questionnaire administered to patients selected in the study. Visual and refractive outcomes, including vector analysis of astigmatism, and corneal higher-order aberrations were also compared at 1-year postoperatively. RESULTS: Baseline characteristics were similar between 2 groups (P > 0.05). A slight difference was detected at 12-month follow-up in the refractive cylinder (P = 0.02) and difference vector (P = 0.01) between eyes that had undergone TransPRK versus alcohol-assisted PRK. All other visual and refractive outcomes were similar at 12-month follow-up between both groups. Of note, 9.9% of patients with alcohol-assisted PRK (10/101) reported to the clinic because of tearing and stabbing sensation within 1 week after contact lens removal as opposed to 1% (1/100) of the TransPRK group (P = 0.0097). Subclinical recurrent epithelial erosion symptoms occurred more frequently in alcohol-assisted PRK: soreness to touch, sharp pains, and eyelid sticking occurred in 26.0% versus 6.6%, 32.5% versus 7.9%, and 26.0% versus 6.6% among the patients who were treated with alcohol-assisted PRK versus those who were treated with TransPRK, respectively (P ≤ 0.002). CONCLUSIONS: Single-step TransPRK for myopic eyes yields refractive results similar to those of alcohol-assisted PRK but shows a lesser incidence of early postoperative epithelial erosions and subsequent subclinical recurrent erosions.