Transepithelial Lenticule Removal Tlr : A Novel Femtosecond-Based Approach To Surface Refractive Surgery

To evaluate the safety, efficacy, and visual and refractive outcomes of low-energy dose Transepithelial Lenticule Removal (TLR) performed without mitomycin-C (MMC) for the correction of myopia and myopic astigmatism using a femtosecond laser system with eye-tracking, precise centration, and cyclotorsion compensation and an asymmetric spacing spot/track distances strategy. 

This clinical study was conducted at The Eye Clinic, a private ophthalmic surgery center in Medellin, Colombia.

This prospective observational study included 33 eyes that underwent low-energy dose Epithelial All-femtosecond Surface Excision (EASE) using the SCHWIND ATOS femtosecond laser (total dose: 496 mJ/cm²) without MMC. All procedures were performed by a single surgeon (JA). MS-39 tomography and biometry, PERAMIS ocular aberrometry, visual acuity, and manifest refraction were evaluated preoperatively and at 1 and 3 months postoperatively. Corneal transparency was graded at each follow-up visit.

Mean preop SEQ was −3.30±1.53D (range −1.25 to −6.25), and mean cyl was −1.25±1.17D (up to −4.00). Mean stromal lenticule thickness was 83±24.37µm (range 47–123µm). Treatments were performed with a mean cap thickness of 71±3.9µm to include the epithelium. Mean optical zone was 7.0±0.3mm (range 6.3–7.3), and total lenticule diameter was 7.74±0.27mm (range 7.1–8.1). At 1 month, mean postoperative SEQ was −0.03±0.18D (range −0.25 to +0.50), with 100% of eyes within ±0.50D. Mean postoperative cylinder was 0.00±0.00D, with 100% ≤0.25D. UDVA was equal to or better than preoperative CDVA in 97% of eyes, and 42% gained ≥1 line. One eye lost one line of CDVA. No clinically significant corneal haze was observed; the highest grade recorded was <0.5.

Low-energy dose EASE performed without MMC and an asymmetric spacing spot/track distances strategy demonstrated excellent early safety, efficacy, and refractive accuracy. At 1 month, 97% of eyes achieved UDVA ≥ preoperative CDVA, with 42% gaining ≥1 line and no clinically significant corneal haze observed. These findings suggest that low-energy dose Femto-TransPRK is a promising surface refractive approach with encouraging early outcomes.