Comparative Early Outcomes Of Alcohol-Assisted And Transepithelial Prk In Pain, Epithelial Remodeling, And Nerve Regeneration
Published 2026 - 44th Congress of the ESCRS
Reference: POREF242 | Type: Free paper | DOI: 10.82333/f744-fg82
Authors: Dr Beatriz Costa Vieira* 1 , Dr Daniela Pires 1 , Dr Ana Carolina Abreu 2 , João Marques 1 , Dr Silvia Monteiro 2 , A/Prof. João Melo Beirão 2 , Dr Pedro Meneres 3 , Dr Maria Céu Pinto 1
1Ophthalmology,Unidade Local Saúde Santo Antonio,Porto,Portugal, 2Ophthalmology,Unidade Local Saúde Santo Antonio,Porto,Portugal;Instituto de Ciências Abel Salazar,Porto,Portugal, 3Ophthalmology,Unidade Local Saúde Santo Antonio,Porto,Portugal;Ophthalmology,Instituto de Ciências Abel Salazar,Porto,Portugal
Purpose
To compare alcohol-assisted (aPRK) and transepithelial (tPRK) photorefractive keratectomy regarding patient-reported pain, clinical epithelial signs, structural healing, and functional outcomes.
Setting
Refractive Surgery Unit of the Ophthalmology Department of Unidade Local de Saúde de Santo António (ULSSA), a tertiary hospital in Oporto, Portugal.
Methods
Prospective observational study. Patients underwent bilateral PRK using the Wavelight EX500 excimer laser, with one eye randomly assigned to aPRK and the fellow eye to tPRK, performed 1–2 weeks apart. Eyes were analyzed as aPRK and tPRK groups. Baseline and postoperative assessments included visual acuity, refraction, anterior segment OCT epithelial/stromal mapping (Anterion, Heidelberg), and in vivo confocal microscopy of epithelial and corneal nerve parameters (HRT3 RCM, Heidelberg). Confocal images were analyzed with ImageJ and ACCMetrics. Clinical epithelial signs and ocular pain (Ocular Pain Assessment Survey, day 2) were recorded. Intergroup and correlation analyses were performed.
Results
Sixty-four eyes from 32 PRK candidates were included (mean age 30.0±5.6 years; 37.5% female). Baseline visual, refractive, epithelial, and nerve parameters were similar between groups. Pain scores did not differ between techniques (4.49 (tPRK) vs 4.52 (aPRK), p=0.96), but were higher during the second procedure (5.18 vs 3.85, p=0.048). Pain correlated with the presence of a healing ridge line on day 3 (p=0.009), but not with preoperative corneal nerve fiber density (CNFD) (p=0.987). CNFD regeneration was comparable at 1 and 3 months (p>0.8). tPRK showed greater epithelial thickness on day 3 (p=0.04), while epithelial cells were larger after aPRK at 3 months (p=0.004). Visual acuity outcomes were similar.
Conclusions
Postoperative pain after PRK was influenced more by surgical sequence and the presence of a healing ridge line than by the surgical technique and was not associated with preoperative corneal nerve fiber density. Nerve regeneration was comparable between groups during the first 3 months. tPRK showed faster epithelial thickening and a trend toward better early refractive outcomes, although visual acuity results were similar between techniques. Overall, both approaches were safe and effective, with tPRK showing modest advantages during the early healing phase.