**Background:** Transepithelial photorefractive keratectomy (Trans PRK) is a no-touch surface ablation technique that combines epithelial and stromal ablation in a single step. While extensively studied for myopia, its application for hyperopia correction remains poorly characterized. This narrative review aims to summarize the available evidence on the outcomes, complications, and challenges of Trans PRK for hyperopia correction.
**Methods:** The authors conducted a narrative review of the literature, identifying four key studies that reported outcomes of Trans PRK for hyperopia correction: Moghaddam et al (55 eyes, Amaris laser, 12-month follow-up), Ortueta et al (43 eyes, Amaris laser, 3-month follow-up), Goggin et al (iRes laser, 3-month follow-up), and Abdel-Radi et al (WaveLight EX500 StreamLight, 12-month follow-up). Inclusion criteria across studies included hyperopia ranging from +0.5 D to +6.0 D, with or without astigmatism up to −3.0 D. Contraindications were similar to conventional PRK, including high astigmatism >3.0 D, corneal ectasias, severe dry eye, and systemic diseases affecting healing. Surgical technique involved pupil-centered or corneal vertex-centered ablation with an optical zone of 6.5–7.6 mm for stroma and 8.0–8.9 mm for epithelium. Mitomycin C 0.02% was used in two studies for 30–60 seconds. Post-operative regimens included topical antibiotics, lubricants, and in some cases steroids and oral vitamin C.
**Key Results:** Uncorrected visual acuity (UCVA) improved significantly in all studies. Moghaddam et al reported a mean pre-operative UCVA of 0.54 ± 0.05 logMAR improving to 0.15 ± 0.03 logMAR at 12 months, with 64.2% of eyes achieving 20/25 or better. Abdel-Radi et al reported improvement from 0.53 ± 0.02 to 0.08 ± 0.01 logMAR (P < 0.001), with all eyes achieving 20/40 or better. Best corrected visual acuity (BCVA) was stable, with no loss of two or more Snellen lines in any study. Spherical equivalent (SEQ) improved from a mean of +2.56 ± 1.90 D to +0.05 ± 0.13 D (Moghaddam et al) and from +3.21 ± 0.61 D to +0.41 ± 0.04 D (Abdel-Radi et al). Predictability (SEQ within ±0.5 D of target) was 76.2% in Moghaddam et al, 91% in Ortueta et al, and 72.9% in Abdel-Radi et al. Astigmatism improved from −0.94 ± 0.12 D to −0.71 ± 0.12 D (Moghaddam et al) and from 0.93 ± 0.11 D to 0.39 ± 0.04 D (Abdel-Radi et al). Regression was higher in moderate hyperopia (>3.00 D) compared to low hyperopia (≤3.00 D), with a regression rate of 0.17 ± 0.03 D/month in the first 6 months and 0.004 ± 0.01 D/month in the subsequent 6 months. Complications were limited: Moghaddam et al reported peripheral corneal haze in 5 eyes (all moderate hyperopia), which cleared in one eye by 1 year; no other complications were reported in the other studies.
**Clinical Implications:** Trans PRK appears to be a safe and effective option for low hyperopia correction, with faster epithelial healing (2–3 days vs 3–5 days for conventional PRK) and lower post-operative pain (pain score 2.00 ± 1.39 vs 4.12 ± 1.40 at 48 hours, as reported in myopia studies). However, for moderate to high hyperopia, outcomes are less predictable, with higher regression and risk of peripheral haze. The use of larger optical zones (>6.5 mm) may improve outcomes, but further refinement of ablation profiles and longer follow-up are needed. The lack of comparative studies with LASIK, SMILE, or conventional PRK for hyperopia limits the ability to draw definitive conclusions. Future research should focus on prospective comparative trials with standardized protocols and longer follow-up to establish the role of Trans PRK in hyperopia correction.