ESCRS 2026: 3-year data show trans-epithelial PRK matches conventional PRK in safety and efficacy

Speaking at the 44th Congress of the European Society of Cataract and Refractive Surgeons (ESCRS 2026; September 11–15; London, UK), Robert Ang, MD, presented long-term outcomes comparing trans-epithelial photorefractive keratectomy (TransPRK) with conventional alcohol-assisted PRK. Three-year follow-up data showed the two techniques achieved comparable refractive outcomes, safety, and patient comfort.

Study design

Ang, of the Asian Eye Institute in the Philippines, has practised refractive surgery for 25 years and described TransPRK as “a game changer.” The study used a contralateral-eye design: one eye of each patient was randomised to TransPRK using the Bausch + Lomb Teneo M2 laser, and the fellow eye received conventional PRK with alcohol-assisted epithelial removal. Unlike conventional PRK, TransPRK is performed as a single step, with the laser ablating the epithelium and then correcting the refractive error without an alcohol de-epithelialisation stage. A default epithelial thickness of 54 μm was used, though Ang noted this can be customised with data from an epithelial mapping device. Both eyes received mitomycin C 0.02% for 30 seconds to reduce the risk of haze.

Refractive and safety outcomes

From a mean baseline of −3.6 D spherical equivalent, both groups achieved near-plano refractive outcomes at one year, a result that persisted to 36 months; at three-year follow-up, mean cylinder was approximately 0.4 D. Uncorrected distance visual acuity of 20/20 was achieved in approximately 96% of eyes in both groups, and no eyes in either group lost lines of best-corrected vision, indicating good safety in both arms.

Patient comfort and healing

Patient questionnaires showed no statistically significant difference between groups in re-epithelialisation time, with corneas fully epithelialising in roughly two-and-a-half to three days in both arms. Pain levels were also equivalent between groups and lasted around two days. Ang noted this was contrary to his expectation that TransPRK would cause less discomfort. No cases of corneal haze were reported in either group through six months of follow-up.

Clinical adoption

Based on these outcomes, Ang has shifted the majority of his patients to TransPRK, citing its safety, efficacy, and shorter procedure time, which allows him to treat more patients per day. He continues to use manual epithelial debridement with conventional PRK in two situations: patients with a history of recurrent epithelial erosion, and retreatment or enhancement cases, where the evenness of the residual epithelium cannot be reliably assessed.

Next steps

Ang noted that extending TransPRK to irregular corneas or eyes with suspicious topography would require a separate study incorporating different nomogram adjustments, as the current data were generated in patients undergoing routine refractive surgery.