In Vivo Early Visual Outcomes and Corneal Biomechanical Properties after Combined Transepithelial Phototherapeutic Keratectomy (t-PTK), with Topography Guided Photorefractive Keratectomy (t-PRK) and Accelerated Corneal Crosslinking (ACXL) for Keratoconus: A Case Report

Purpose is to report a case of in vivo early visual outcomes and corneal biomechanical properties after combined transepithelial phototherapeutic keratectomy (t-PTK), topography guided photorefractive keratectomy (t-PRK) and accelerated corneal crosslinking (ACXL) for keratoconus. Case Details and results: A 23 year old male with unilateral keratoconus underwent combined topography guided photorefractive keratectomy (t-PRK) using the CATz module of Nidek EC 5000 CX III excimer laser (NIDEK Co Ltd, Gamagori, Japan) and accelerated corneal crosslinking (ACXL) using CCL 365 vario (MLase AG, Germany). Post surgery, we noted reduction in manifest refraction astigmatism, spherical equivalent, steep keratometry, Kmax. Improvement in corneal stiffness was noted. There was reduction in deformation amplitude, highest concavity peak, highest concavity radius, DA ratio suggesting improved biomechanics. Conclusion: Combined t-PRK+ t-PTK+ CXL in keratoconus not only improve the visual outcomes but also stabilize the cone biomechanics as shown by the increase in the corneal stiffness parameter and regularize the corneal shape.