Retrospective Analysis Of Photorefractive Keratectomy Outcomes In 65,211 Eyes: Comparison Between Myopic Teens And Adults

Photorefractive keratectomy (PRK) is a widely used procedure for myopia correction, often preferred over LASIK in patients with thinner corneas or at higher risk of trauma. However, its safety and efficacy in teenage patients remain controversial due to concerns about refractive stability, healing response, and potential complications such as ectasia. This study provides a large-scale retrospective analysis of 65,211 eyes to compare PRK outcomes in myopic teens (17-18 years) and adults (19-40 years), focusing on visual acuity, efficacy, safety, retreatment rates, and postoperative ectasia rates to determine whether PRK is a viable option for younger patients.

Retrospective cohort study conducted at Care-Vision Laser Centers, Tel Aviv, analyzing PRK outcomes from January 2010 to June 2024.

This retrospective cohort study analyzed 65,211 eyes that underwent PRK at a high-volume refractive surgery center between January 2010 and June 2024. Patients aged 17-40 years with myopia up to -12.0D were divided into two groups: teens (17-18 years) and adults (19-40 years). Preoperative parameters, including corneal thickness, keratometry, and refraction, were compared. Intraoperative details such as optical zone size, ablation depth, and residual stromal bed were analyzed. Postoperative outcomes, including uncorrected and corrected distance visual acuity, efficacy, safety, retreatment rates, and the incidence of postoperative ectasia, were evaluated with statistical adjustments for confounders.

Preoperatively, teens had thicker corneas (536.8 ± 32.7 vs. 528.3 ± 33.7 μm, p < 0.0001) and lower keratometry values. Postoperatively, UDVA was slightly better in teens (0.9646 ± 0.1072 vs. 0.9507 ± 0.1289, p = 0.0815), with a higher efficacy index (1.022 ± 0.1126 vs. 1.015 ± 0.1339, p = 0.0497). No significant differences were found in subjective refraction or corrected distance visual acuity. Retreatment rates (0.41% in both groups, p = 0.7987) and ectasia rates (0.024% vs. 0.026%, p = 0.5778) were similar. These findings suggest that PRK in teens achieves comparable or slightly better visual outcomes without increased risk.

PRK in myopic teens is a safe and effective procedure with visual outcomes comparable to or slightly better than those in adults. Teens demonstrated a higher efficacy index with no increase in retreatment rates or postoperative ectasia, suggesting that age alone should not be a limiting factor for PRK candidacy. These findings challenge existing concerns about performing PRK in younger patients and support its use as a viable option in appropriately selected teens. Given the large sample size and robust statistical analysis, this study provides strong evidence that PRK offers excellent safety and efficacy across a broad age range, reinforcing its role in refractive surgery for myopia.