ObjectivesTo assess and compare the six-month outcome of the two-step transepithelial phototherapeutic keratectomy- photorefractive keratectomy (PTK-PRK) and the single-step transepithelial PRK for myopia and myopic astigmatism.MethodsA prospective randomized study. The study enrolled 100 eyes of 50 patients with mild to moderate myopia or myopic astigmatism stratified into two groups, PTK-PRK (n= 50 eyes) and single step PRK (n= 50 eyes). Primary outcome measures were visual acuity and manifest refraction. Secondary outcome measures were epithelial healing duration, post-PRK pain scores and 3-month postoperative haze grading.ResultsPreoperative characteristics were similar in both groups (pvalue > 0.05). The mean uncorrected distance visual acuity (UDVA) at 1 week, 1 month, 3 and 6 months was significantly better in the single-step PRK group than in the two-step PTK-PRK group (p< 0.001). The mean manifest sphere, cylinder and spherical equivalent showed a significant difference at all follow up visits in favour of the single-step PRK (pvalue < 0.001). Epithelial healing duration was faster in single-step PRK (pvalue < 0.001). Pain scores were significantly lower following single-step PRK at 8 h, 1 day, 3 days (pvalue < 0.001) but were similar at the 7th day. Haze scores showed no statistical difference between the two groups at 3-month follow-up.ConclusionThe two transepithelial PRK techniques were effective in correcting mild to moderate myopia and myopic astigmatism. However, Single-step transepithelial PRK achieved faster visual recovery, better refractive outcome and shorter epithelial healing time with less post-PRK pain.Clinical trials registry(Clinical Trials.gov Identifier): NCT04710082.