One-Year Visual and Refractive Outcomes of SmartPulse® Technology in Transepithelial Photorefractive Keratectomy for Myopic and Astigmatic Patients

Abstract

Background/Objectives: This study aims to evaluate the efficacy, safety, and predictability of Transepithelial Photorefractive Keratectomy (TPRK) using the SmartPulse^® technology excimer laser for the correction of myopia and myopic astigmatism, assessing visual and refractive outcomes over a one-year follow-up period. Methods: This retrospective cohort study analyzed data from patients who underwent TPRK at the Ophthalmology Department-"Victor Babes" University of Medicine and Pharmacy in Timisoara (Romania), between January 2019 and June 2023. The procedure was performed using the SmartPulse^® Technology of the SmartSurf^ACE AMARIS 750S excimer laser (SCHWIND eye-tech-solutions, Kleinostheim, Germany). Preoperative assessments included visual acuity, refraction, and corneal measurements, with postoperative evaluations conducted for up to 12 months. Results: This study included 92 eyes from 46 patients (mean age 29.02 years, 63% male). At 12 months post-op, 100% achieved UDVA 20/25 or better, with an efficacy index of 1.01. Refractive accuracy was 96% within ±0.50 D of the target and astigmatism ≤ 0.50 D in 99% of eyes. The safety index was 1.01. Corneal haze occurred in 8.70% of eyes and was effectively managed with dexamethasone drops. Conclusions: TPRK with the SmartPulse^® technology excimer laser demonstrated high efficacy and safety in correcting myopia and myopic astigmatism, achieving stable visual outcomes over one year. The procedure also showed excellent predictability with a low incidence of complications, supporting its use as a reliable refractive surgery option.

Keywords: SmartPulse® technology; SmartSurfACE; contactless surgery; myopia correction; transepithelial PRK; visual and refractive outcomes.

Figure 1

Visual and refractive outcomes following SmartPulse^®-enhanced transepithelial PRK based on the standard nine graphs design by Reinstein. (A) Uncorrected distance visual acuity. (B) Uncorrected distance visual acuity vs. corrected distance visual acuity. (C) Change in corrected distance visual acuity. (D) Spherical equivalent refraction attempted vs. achieved. (E) Spherical equivalent refraction accuracy (F) Spherical equivalent refraction stability. (G) Refractive astigmatism. (H) Target-induced astigmatism vs. surgically-induced astigmatism (I) Refractive astigmatism angle of error.

Figure 2

Preoperative vs. postoperative keratometry measurements. Box-and-whisker plots showing changes in mean (white), maximum (blue), and minimum (red) keratometry measurements in diopters (D) from preoperative to postoperative assessments. Statistically significant decreases are noted across all measurements with t-values and p-values indicating robust changes. Outliers are marked with circles.