Akram Sharmeen, Moazzum Wardah, Abid Khadijah
Department of Ophthalmology and Visual Sciences, Aga Khan Univesity Hospital, Karachi, Pakistan.
BMC Ophthalmol. 2025 Feb 26;25(1):93. doi: 10.1186/s12886-024-03830-x.
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.
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.
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.
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.
The protocol of this systematic review was registered on PROSPERO with ID CRD42024494717.
本系统评价评估了单步经上皮准分子激光角膜切削术（tPRK）在术后疼痛、上皮愈合、术后 haze 及视力方面的疗效。在有数据的情况下，还将单步 tPRK 与两步 tPRK 进行了比较。
本系统评价遵循 PRISMA 报告指南（系统评价和 Meta 分析的首选报告项目）。在 PUBMED、Scopus 和谷歌学术上进行了电子文献检索。使用纽卡斯尔渥太华量表（NOS）评估本系统评价中纳入研究的质量。本系统评价的方案已在 PROSPERO 上注册，注册号为 CRD42024494717。
本系统评价纳入了 2013 年至 2023 年期间发表的 11 项研究。研究表明，单步 tPRK 和两步 tPRK 在视力方面均有显著改善。两项研究表明，与两步 tPRK 相比，单步 tPRK 不仅提供了更好的未矫正远视力（UDVA），而且在不同随访期的明显球镜、柱镜和等效球镜方面也有显著改善。一项研究证明了单步 tPRK 在低、中、高严重程度组近视矫正中的广泛有效性。快速上皮愈合是一个一致的发现。在其中一项研究中，100%接受单步 tPRK 治疗的眼睛在 72 小时内实现了完全上皮愈合。在各项研究中，tPRK 后角膜 haze 的发生率普遍较低。单步 tPRK 组术后疼痛评分最初较低。一项研究报告称，单步 tPRK 组术后前四天的最大疼痛程度明显低于两步 tPRK 组。
两步和单步 tPRK 都是安全的屈光手术。单步 tPRK 由于 haze 形成较少、疼痛评分较低、愈合较快且在提高视力方面效果更佳，优于两步技术。
本系统评价的方案已在 PROSPERO 上注册，注册号为 CRD42024494717。
