The efficacy, safety and predictability in transepithelial photorefractive keratectomy versus LASIK/SMILE: A meta-analysis

Purpose This meta-analysis aimed to evaluate the studies comparing transepithelial photorefractive keratectomy (TransPRK) to LASIK (Laser-Assisted In Situ Keratomileusis)/SMILE (Small Incision Lenticule Extraction) in terms of visual outcomes for myopia, astigmatism and hyperopia. Methods Studies from PubMed ® were included based on predefined criteria comparing TransPRK to LASIK/SMILE in terms of efficacy, efficacy index, safety, safety index, predictability, correction index, difference vector or index of success. A random-effects meta-analysis provided standardized mean differences, odds ratios (OR) and 95% confidence intervals (CI). Results 17 studies with 5686 treated eyes met the inclusion criteria. Compared to LASIK, TransPRK showed a log(OR) of 0.09 (CI: −0.34 to 0.52) for efficacy, −0.85 (CI: −1.40 to −0.31) for safety (favoring LASIK) and 0.08 (CI: −0.28 to 0.44) for predictability. Compared to SMILE, TransPRK had a log(OR) of 0.77 (CI: −0.29 to 1.84) for efficacy, −0.3 (CI: −2.27 to 1.67) for safety and −0.91 (CI: −1.82 to 0) for predictability. Conclusion No statistically significant differences were found between TransPRK and LASIK/SMILE in terms of efficacy and predictability. LASIK did show a significant safety advantage compared to TransPRK (negative log[OR], p < 0.05) in the astigmatism and low-to-moderate myopia subgroup but the safety index did not. Procedure choice should be based on patient characteristics, laser availability, complication risk and surgeon experience, and not by performance in efficacy, safety or predictability While LASIK has a lower incidence of haze formation and SMILE offers a better biomechanical stability, TransPRK remains a suitable option especially in the hands of a less experienced surgeon.