Two Strategies in Transepithelial PRK: A Systematic Review and Network Meta-Analysis
- Journal
- Journal of cataract and refractive surgery (Q1)
- Published
- 4 November 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Raghad Saleh Alajlan, Turad Alkadi, Danah Alqahtani, Mashael Alsugair, Shahad Alrowais, Sarah Taishan, et al.
- PMID
- 42980609
- DOI
- 10.1097/j.jcrs.0000000000002093
Why clinicians should know about it
- Picked for Ophthalmology (top studies of the week, 8 November 2026): Comparative evidence on refractive surgery outcomes
Abstract
TOPIC: To compare efficacy, refractive predictability, safety, and early recovery after single-step transepithelial photorefractive keratectomy (TransPRK) using StreamLight and SmartSurfACE in myopic eyes through network meta-analysis. CLINICAL RELEVANCE: TransPRK is a flap-free surface ablation option for myopic patients. Direct comparative evidence between TransPRK technologies remains limited. METHODS: PubMed/MEDLINE, Embase, Cochrane Central, and Web of Science were searched from inception to October 31, 2025. Randomized trials, cohort studies, and case series evaluating single-step TransPRK using StreamLight or SmartSurfACE were included. Alcohol-assisted photorefractive keratectomy (aaPRK) served as the common comparator. Random-effects network meta-analysis was performed. RESULTS: Forty-two studies were included; 15 contributed to the network meta-analysis. No significant differences were detected between StreamLight and SmartSurfACE in efficacy (uncorrected distance visual acuity [UDVA] ≥20/20; odds ratio [OR] 0.75, 95% confidence interval [CI] 0.13-4.22), predictability (±0.50 diopters; OR 1.11, 95% CI 0.27-4.61), postoperative spherical equivalent (standardized mean difference [SMD] 0.02, 95% CI -0.31 to 0.35), or safety index (SMD -0.28, 95% CI -1.89 to 1.34). Loss of ≥2 lines of corrected distance visual acuity (CDVA) was rare. StreamLight was associated with faster epithelial healing (SMD -2.03, 95% CI -3.26 to -0.80), approximately 1-1.5 days earlier. Pain and haze were similar. No significant inconsistency was detected. CONCLUSION: No significant differences were detected between StreamLight and SmartSurfACE in efficacy, refractive predictability, or safety for myopic TransPRK. The observed epithelial-healing advantage with StreamLight was based on indirect evidence and should be interpreted cautiously.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.