SavedAdd your journal

Journals / Hitit Medical Journal / 2026 / Cilt: 8 Sayı: 3

The Role of Photorefractive Keratectomy in Modern Refractive Surgery

Fotorefraktif Keratektominin Modern Refraktif Cerrahideki Yeri

Çağatay Çağlar(MALTEPE ÜNİVERSİTESİ, TIP FAKÜLTESİ)0000-0003-4391-2571
Fatih Güven(MALTEPE ÜNİVERSİTESİ, TIP FAKÜLTESİ)0000-0003-3587-7403
Pages
756–769
Publication Date
2026-10-14
🏛️Bibliographic metadata and full text access for this article are provided via DergiPark.
DergiPark Record ↗
✨

AI Summary & Key Takeaways

AI Insight
⚡ TL;DR(Too Long; Didn't Read)

PRK is based on excimer laser ablation following removal of the corneal epithelium.

📌 3 Key Takeaways

🎯
Objective & Hypothesis:Photorefractive keratectomy (PRK) remains a cornerstone of modern refractive surgery and retains its clinical relevance in the era of small-incision lenticule extraction because of recent technological advances such as transepithelial techniques and optimized ablation profiles.
📊
Key Findings & Data:This review comprehensively examines the historical development, contemporary techniques, and role of PRK in modern refractive surgery.
💡
Conclusion & Impact:PRK is based on excimer laser ablation following removal of the corneal epithelium.
🔬Design:Review & Systematic Survey
📍Scope:Comprehensive Sample
⚙️Variables:Eksimer Lazer · Kornea · PRK

Abstract

Photorefractive keratectomy (PRK) remains a cornerstone of modern refractive surgery and retains its clinical relevance in the era of small-incision lenticule extraction because of recent technological advances such as transepithelial techniques and optimized ablation profiles. This review comprehensively examines the historical development, contemporary techniques, and role of PRK in modern refractive surgery. PRK is based on excimer laser ablation following removal of the corneal epithelium.

Özet

Fotorefraktif keratektomi (PRK), transepitelyal teknikler ve optimize edilmiş ablasyon profilleri gibi son teknolojik gelişmeler sayesinde küçük insizyonlu lentikül ekstraksiyonu çağında da klinik önemini koruyarak modern refraktif cerrahinin temel taşlarından biri olmaya devam etmektedir. Bu derlemede, kornea epitelinin kaldırılmasını takiben uygulanan eksimer lazer ablasyonuna dayanan PRK yönteminin tarihsel gelişimi, güncel uygulama teknikleri ve modern cerrahideki yeri kapsamlı bir şekilde ele alınmıştır.

🔖

Cite This Article

Çağlar, Ç., Güven, F. (2026). The Role of Photorefractive Keratectomy in Modern Refractive Surgery. Hitit Medical Journal, Cilt: 8 Sayı: 3, 756–769. https://doi.org/10.52827/hititmedj.1919401

📄 Full Text PDF Viewer

📄

PDF görüntüleyici hazırlanıyor...

References (75)

  1. Ambrósio R Jr, Wilson S. LASIK vs LASEK vs PRK: advantages and indications. Semin Ophthalmol. 2003;18(1):2-10.
  2. Trokel SL, Srinivasan R, Braren B. Excimer laser surgery of the cornea. Am J Ophthalmol. 1983;96(6):710-715.
  3. Ang M, Gatinel D, Reinstein DZ, Mertens E, Alió Del Barrio JL, Alió JL. Refractive surgery beyond 2020. Eye (Lond) 2021;35(2):362-382.
  4. Gurnani B, Kaur K. Recent Advances in Refractive Surgery: An Overview. Clin Ophthalmol. 2024; 2;18:2467-2472.
  5. Shams SS, Hassanzadeh S, Zarei-Ghanavati S, Ziaei M, Bayati S. Predictive factors for outcomes of photorefractive keratectomy in myopic eyes. Int J Ophthalmol. 2025; 18;18(11):2143-2148.
  6. Stein R. Photorefractive keratectomy. Int Ophthalmol Clin. 2000;40(3):35-56.
  7. Naderi M, Ghadamgahi S, Jadidi K. Photorefractive Keratectomy (PRK) is Safe and Effective for Patients with Myopia and Thin Corneas. Med Hypothesis Discov Innov Ophthalmol. 2016;5(2):58-62.
  8. Lee BS, Gupta PK, Davis EA, Hardten DR. Outcomes of photorefractive keratectomy enhancement after LASIK. J Refract Surg. 2014;30(8):549-556.
  9. Roszkowska AM, Urso M, Signorino GA, Spadea L, Aragona P. Photorefractive keratectomy after cataract surgery in uncommon cases: long-term results. Int J Ophthalmol 2018;11(4):612-615.
  10. Bower KS, Woreta F. Update on contraindications for laser-assisted in situ keratomileusis and photorefractive keratectomy. Curr Opin Ophthalmol. 2014;25(4):251-257.
  11. Moshirfar M, Barke MR, Huynh R, et al. Controversy and Consideration of Refractive Surgery in Patients with Heritable Disorders of Connective Tissue. J Clin Med. 2021; 24;10(17):3769.
  12. Khakshoor H, Razavi F, Eslampour A, Omdtabrizi A. Photorefractive keratectomy in mild to moderate keratoconus: outcomes in over 40-year-old patients. Indian J Ophthalmol. 2015;63(2):157-161.
  13. He Y, Ma BS, Zeng JH, Ma DJ. Corneal optical density: Structural basis, measurements, influencing factors, and roles in refractive surgery. Front Bioeng Biotechnol. 2023; 6;11:1144455.
  14. de Oliveira RC, Murillo S, Saikia P, Wilson SE. The Efficacy of Topical HGF on Corneal Fibrosis and Epithelial Healing after Scar-Producing PRK Injury in Rabbits. Transl Vis Sci Technol. 2020; 30;9(4):29.
  15. Shapira Y, Mimouni M, Levartovsky S, et al. Comparison of Three Epithelial Removal Techniques in PRK: Mechanical, Alcohol-assisted, and Transepithelial Laser. J Refract Surg. 2015;31(11):760-766.
  16. Ghoreishi M, Attarzadeh H, Tavakoli M, et al. Alcohol-assisted versus Mechanical Epithelium Removal in Photorefractive Keratectomy. J Ophthalmic Vis Res. 2010;5(4):223-227.
  17. Gimbel HV, DeBroff BM, Beldavs RA, van Westenbrugge JA, Ferensowicz M. Comparison of laser and manual removal of corneal epithelium for photorefractive keratectomy. J Refract Surg. 1995;11(1):36-41.
  18. Lee HK, Lee KS, Kim JK, Kim HC, Seo KR, Kim EK. Epithelial healing and clinical outcomes in excimer laser photorefractive surgery following three epithelial removal techniques: mechanical, alcohol, and excimer laser. Am J Ophthalmol. 2005;139(1):56-63.
  19. Campos M, Szerenyi K, Lee M, McDonnell JM, Lopez PF, McDonnell PJ. Keratocyte loss after corneal deepithelialization in primates and rabbits. Arch Ophthalmol. 1994;112(2):254-260.
  20. Einollahi B, Baradaran-Rafii A, Rezaei-Kanavi M, et al. Mechanical versus alcohol-assisted epithelial debridement during photorefractive keratectomy: a confocal microscopic clinical trial. J Refract Surg. 2011;27(12):887-893.
  21. Abad JC, An B, Power WJ, et al. A prospective evaluation of alcohol-assisted versus mechanical epithelial removal before photorefractive keratectomy. Ophthalmology. 1997;104(10):1566-74; discussion 1574-1575.
  22. Taneri S, Kießler S, Rost A, Schultz T, Dick HB. Epi-Bowman keratectomy versus alcohol-assisted photorefractive keratectomy: wound healing and complications. Ther Adv Ophthalmol. 2021; 22;13:2515841420988215.
  23. Zhao LQ, Wei RL, Cheng JW, Li Y, Cai JP, Ma XY. Meta-analysis: clinical outcomes of laser-assisted subepithelial keratectomy and photorefractive keratectomy in myopia. Ophthalmology. 2010;117(10):1912-1922.
  24. Fattah MA, Antonios R, Arba Mosquera S, Abiad B, Awwad ST. Epithelial Erosions and Refractive Results After Single-Step Transepithelial Photorefractive Keratectomy and Alcohol-Assisted Photorefractive Keratectomy in Myopic Eyes: A Comparative Evaluation Over 12 Months. Cornea. 2018;37(1):45-52.
  25. Fadlallah A, Fahed D, Khalil K, et al. Transepithelial photorefractive keratectomy: clinical results. J Cataract Refract Surg. 2011;37(10):1852-1857
  26. Celik U, Bozkurt E, Celik B, Demirok A, Yilmaz OF. Pain, wound healing and refractive comparison of mechanical and transepithelial debridement in photorefractive keratectomy for myopia: results of 1 year follow-up. Cont Lens Anterior Eye. 2014;37(6):420-426
  27. Naderi M, Jadidi K, Mosavi SA, Daneshi SA. Transepithelial Photorefractive Keratectomy for Low to Moderate Myopia in Comparison with Conventional Photorefractive Keratectomy. J Ophthalmic Vis Res. 2016;11(4):358-362.
  28. Yildirim Y, Olcucu O, Alagoz N, Agca A, Karakucuk Y, Demirok A. Comparison of visual and refractive results after transepithelial and mechanical photorefractive keratectomy in myopia. Int Ophthalmol. 2018;38(2):627-633.
  29. Hashemi H, Alvani A, Aghamirsalim M, Miraftab M, Asgari S. Comparison of transepithelial and conventional photorefractive keratectomy in myopic and myopic astigmatism patients: a randomized contralateral trial. BMC Ophthalmol. 2022; 11;22(1):68.
  30. Gadde AK, Srirampur A, Katta KR, Mansoori T, Armah SM. Comparison of single-step transepithelial photorefractive keratectomy and conventional photorefractive keratectomy in low to high myopic eyes. Indian J Ophthalmol. 2020;68(5):755-761.
  31. Munnerlyn CR, Koons SJ, Marshall J. Photorefractive keratectomy: a technique for laser refractive surgery. J Cataract Refract Surg. 1988;14(1):46-52.
  32. Özdoğan S, Gürelik G, Bilgihan K. Analysis of corneal biomechanical properties 25 years after myopic photorefractive keratectomy. Int Ophthalmol. 2023;43(1):325-331.
  33. Tomás-Juan J, Murueta-Goyena Larrañaga A, Hanneken L. Corneal Regeneration After Photorefractive Keratectomy: A Review. J Optom. 2015;8(3):149-169.
  34. Zheng Y, Zhai CB. Performance of Bandage Contact Lens in Patients Post-ocular Surgeries: A Systematic Literature Review. Eye Contact Lens. 2023; 1;49(11):449-458.
  35. O'Brart DP. Excimer laser surface ablation: a review of recent literature. Clin Exp Optom. 2014;97(1):12-17.
  36. de Benito-Llopis L, Teus MA. Epi-LASIK versus LASEK and PRK. J Cataract Refract Surg. 2012;38(4):732; author reply 732-733.
  37. Semnani F, Rayati Damavandi A, Abdollahi M, Sajadi M, Sadoughi MM, Hassanpour K. Photorefractive keratectomy in patients with thin corneas: systematic review and meta-analysis of clinical outcomes and complications. J Cataract Refract Surg. 2026; 1;52(1):93-103.
  38. Hashemi M, Amiri MA, Tabatabaee M, Ayatollahi A. The results of photorefractive keratectomy with Mitomycin-C in myopia correction after 5 years. Pak J Med Sci. 2016;32(1):225-228.
  39. Alio JL, Soria FA, Abbouda A, Peña-García P. Fifteen years follow-up of photorefractive keratectomy up to 10 D of myopia: outcomes and analysis of the refractive regression. Br J Ophthalmol. 2016;100(5):626-632.
  40. Guerin MB, Darcy F, O'Connor J, O'Keeffe M. Excimer laser photorefractive keratectomy for low to moderate myopia using a 5.0 mm treatment zone and no transitional zone: 16-year follow-up. J Cataract Refract Surg. 2012;38(7):1246-1250.
  41. Moon CH. Four-year visual outcomes after photorefractive keratectomy in pilots with low-moderate myopia. Br J Ophthalmol. 2016;100(2):253-257
  42. Abing AA, Oh A, Ong LF, Marvasti AH, Tran DB, Lee JK. Surgical options and clinical outcomes for high myopia. Curr Opin Ophthalmol. 2024; 1;35(4):284-291.
  43. Adib-Moghaddam S, Soleyman-Jahi S, Adili-Aghdam F, Arba Mosquera S, Hoorshad N, Tofighi S. Single-step transepithelial photorefractive keratectomy in high myopia: qualitative and quantitative visual functions. Int J Ophthalmol. 2017; 18;10(3):445-452.
  44. Katz T, Wagenfeld L, Galambos P, Darrelmann BG, Richard G, Linke SJ. LASIK versus photorefractive keratectomy for high myopic (> 3 diopter) astigmatism. J Refract Surg. 2013;29(12):824-831.
  45. Mimouni M, Pokroy R, Rabina G, Kaiserman I. LASIK versus PRK for high astigmatism. Int Ophthalmol. 2021;41(6):2091-2098.
  46. Gershoni A, Reitblat O, Mimouni M, Livny E, Nahum Y, Bahar I. Femtosecond laser assisted in situ keratomileusis (FS-LASIK) yields better results than transepithelial photorefractive keratectomy (Trans-PRK) for correction of low to moderate grade myopia. Eur J Ophthalmol. 2021;31(6):2914-2922.
  47. Sher NA. Hyperopic refractive surgery. Curr Opin Ophthalmol. 2001;12(4):304-308.
  48. Kaluzny BJ, Piotrowiak-Slupska I, Kaszuba-Modrzejewska M, Stachura J, Arba-Mosquera S, Verma S. Three-year outcomes after high hyperopia correction using photorefractive keratectomy with a large ablation zone. Br J Ophthalmol. 2019;103(6):849-854.
  49. Spadea L, Sabetti L, D'Alessandri L, Balestrazzi E. Photorefractive keratectomy and LASIK for the correction of hyperopia: 2-year follow-up. J Refract Surg. 2006;22(2):131-136.
  50. Asroui L, Arba-Mosquera S, Torbey J, et al. Long-term results of hyperopic ablations using alcohol-assisted PRK and FS-LASIK: comparative study. J Cataract Refract Surg. 2023; 1;49(7):716-723.
  51. Abdel-Radi M, Rateb M, Saleh MGA, Aly MOM. Twelve-month outcomes of single-step transepithelial photorefractive keratectomy for moderate hyperopia and hyperopic astigmatism. Eye Vis (Lond) 2023;10(1):7.
  52. Almutairi MN, Alshehri AM, Alhoumaily AY, Alnahdi O, Taha MA, Gangadharan S. Meta-analysis: clinical outcomes of laser-assisted in situ keratomileusis (LASIK) and photorefractive keratectomy (PRK) in hyperopia. BMC Ophthalmol. 2025; 18;25(1):140.
  53. Wagh VK, Dave R, O'Brart DP, et al. Eighteen-year follow-up of hyperopic photorefractive keratectomy. J Cataract Refract Surg. 2016;42(2):258-266.
  54. Shortt AJ, Allan BD, Evans JR. Laser-assisted in-situ keratomileusis (LASIK) versus photorefractive keratectomy (PRK) for myopia. Cochrane Database Syst Rev. 2013; 31;2013(1):CD005135.
  55. Wen D, McAlinden C, Flitcroft I, et al. Postoperative Efficacy, Predictability, Safety, and Visual Quality of Laser Corneal Refractive Surgery: A Network Meta-analysis. Am J Ophthalmol. 2017;178:65-78.
  56. Li SM, Zhan S, Li SY, et al. Laser-assisted subepithelial keratectomy (LASEK) versus photorefractive keratectomy (PRK) for correction of myopia. Cochrane Database Syst Rev. 2016; 22;2(2):CD009799.
  57. Kuryan J, Cheema A, Chuck RS. Laser-assisted subepithelial keratectomy (LASEK) versus laser-assisted in-situ keratomileusis (LASIK) for correcting myopia. Cochrane Database Syst Rev. 2017; 15;2:CD011080.
  58. Hashemi H, Ghaffari R, Miraftab M, Asgari S. Femtosecond laser-assisted LASIK versus PRK for high myopia: comparison of 18-month visual acuity and quality. Int Ophthalmol. 2017;37(4):995-1001.
  59. Zhang J, Feng Q, Ding W, Peng Y, Long K. Comparison of clinical results between trans-PRK and femtosecond LASIK for correction of high myopia. BMC Ophthalmol. 2020; 19;20(1):243.
  60. Zheng Z, Zhang M, Jhanji V, Sun L, Li J, Zhang R. Comparison between aberration-free transepithelial photorefractive keratectomy and small incision lenticule extraction for correction of myopia and myopic astigmatism. Int Ophthalmol. 2021;41(1):303-314.
  61. Hashemi H, Asgari S, Khabazkhoob M, Heidari Z. Vector analysis of astigmatism correction after PRK, FS-LASIK, and SMILE for myopic astigmatism. Int Ophthalmol. 2023;43(11):3999-4009.
  62. Zhang R, Zhang Y, Yuan Y, Chen Y. Comparison of objective and subjective visual quality after flapless laser vision correction for mild to moderate myopia: SMILE vs PRK. Graefes Arch Clin Exp Ophthalmol. 2023;261(6):1731-1741.
  63. Joshi S, Bari A, Shakkarwal C, et al. The visual outcomes and corneal biomechanical properties after PRK and SMILE in low to moderate myopia. Indian J Ophthalmol. 2025; 1;73(1):128-133.
  64. Taneri S, Knepper J, Rost A, Dick HB. PRK, LASIK, SMILE im Langzeitverlauf [Long-term outcomes of PRK, LASIK and SMILE]. Ophthalmologe. 2022;119(2):163-169.
  65. Sia RK, Ryan DS, Beydoun H, et al. Visual outcomes after SMILE from the first-year experience at a U.S. military refractive surgery center and comparison with PRK and LASIK outcomes. J Cataract Refract Surg. 2020;46(7):995-1002.
  66. Yildirim Y, Olcucu O, Alagoz C, et al. Visual and Refractive Outcomes of Photorefractive Keratectomy and Small Incision Lenticule Extraction (SMILE) for Myopia. J Refract Surg. 2016; 1;32(9):604-610.
  67. Ryan DS, Sia RK, Beydoun H, et al. Quality of Vision and Patient Satisfaction After Refractive Surgery: A Comparative Analysis of LASIK, SMILE, and PRK. J Spec Oper Med. 2025; 30;24(4):86-92.
  68. Al-Mohaimeed MM. Combined corneal CXL and photorefractive keratectomy for treatment of keratoconus: a review. Int J Ophthalmol. 2019;12(12):1929–1938.
  69. Gil P, Gil JQ, Dias M, et al. Safety and Efficacy of Corneal Crosslinking Combined With Phototherapeutic Keratectomy With or Without Topography-Guided Photorefractive Keratectomy. Cornea. 2026; 1;45(7):817-827.
  70. Pop RN, Nicula P, Nicula C, Nicula D, Pop B. Updates on Corneal Collagen Cross-Linking for Keratoconus: A 10-Year Review of Techniques, Clinical Outcomes, and Future Directions. Rom J Ophthalmol. 2026;70(1):42-49.
  71. Moshirfar M, Wang Q, Theis J, et al. Management of Corneal Haze After Photorefractive Keratectomy. Ophthalmol Ther. 2023;12(6):2841-2862.
  72. Ouerdane Y, Zaazouee MS, Mohamed MEA, et al. Mitomycin C application after photorefractive keratectomy in high, moderate, or low myopia: Systematic review and meta-analysis. Indian J Ophthalmol. 2021;69(12):3421-3431.
  73. Kim S, Na S, Choi S, Choi SH. Comparison of Outcomes after Wavefront-optimized and Topography-guided Transepithelial Photorefractive Keratectomy. Korean J Ophthalmol. 2024;38(4):275-283.
  74. Ji Y, Xie L, Liu F, Xu Y, Yang W and Zhang S (2026) Artificial intelligence in refractive surgery: progress, challenges, and future directions. Front. Cell Dev. Biol. 2026;14:1824307.
  75. Friedrich M, Augustin VA, Auffarth GU, Khoramnia R, Son HS. Visual Outcomes and Safety of Ray-Tracing-Guided Laser-Assisted In Situ Keratomileusis: A Systematic Review and Meta-Analysis. Ophthalmol Ther. 2026;15(5):1623-1645.