Twenty-Year Follow-Up of Excimer Laser Photorefractive Keratectomy: A Retrospective Observational Study

Introduction: Photorefractive keratectomy (PRK) was introduced in the late 1980s to correct myopia. The purpose of this study was to assess its long-term efficacy and safety, analyzing patients with at least 20-year follow-up.

Methods: This retrospective observational study was carried out on 85 eyes of 54 patients (33 females) that underwent PRK between 1991 and 1998 (mean age 32.62 ± 9.74, range 18-55 years). Both preoperatively and postoperatively, patients underwent a complete ophthalmological evaluation, including uncorrected and corrected distance visual acuity, slit-lamp, intraocular pressure, dilated fundus, and corneal topographic examinations. The outcome assessment was made by comparing the preoperative refraction, as spherical equivalent, with the postoperative ones, taking into account the planned refractive correction. Safety and efficacy indices were also calculated. All the data were evaluated with a paired t test.

Results: The mean attempted correction as spherical equivalent was - 5.64 ± 3.01 D (range - 1.00 to - 15.00 D), while the mean achieved correction after 20 years was - 4.30 ± 3.13 D (range - 1.88 to - 14.25 D), with a significant statistical difference (p < 0.01). The mean expected refractive outcome was - 0.27 ± 0.81 D (range - 4.00 to + 1.25 D). The mean difference between achieved and attempted treatment was 1.33 ± 1.92 D (range - 4.25 to + 6.25 D), with a significant difference (p < 0.01). The safety index was 1.00 and the efficacy index was 0.63.

Conclusion: The results provided by this study highlight that the procedure could be considered safe, with no long-term sight-threatening complications such as late ectasia or haze.