Simultaneous Topography-guided PRK Followed by Corneal Collagen Cross-Linking for Keratoconus

Purpose: To present the results after simultaneous photorefractive keratectomy (PRK) followed by corneal collagen cross-linking (CXL) for progressive keratoconus. Methods: Twelve patients (14 eyes) with progressive keratoconus were prospectively treated with customized topography-guided PRK with the Pulzar Z1 (wavelength 213 nm, CustomVis) immediately followed by corneal collagen CXL with the use of riboflavin and ultraviolet A irradiation. Results: Mean follow-up was 10.69±5.95 months (range: 3 to 16 months). Mean preoperative spherical equivalent refraction (SE) was −3.03±3.23 diopters (D) and defocus was 4.67±3.29 D; at last follow-up SE and defocus were statistically significantly reduced to −1.29±2.05 D and 3.04±2.53 D, respectively ( P <.01). Preoperative mean (logMAR) uncorrected visual acuity was 0.99±0.81 and best spectacle-corrected visual acuity was 0.21±0.19, which improved postoperatively to 0.16±0.15 and 0.11±0.15, respectively. The mean steepest keratometry was reduced from 48.20±3.40 D preoperatively to 45.13±1.80 D at last follow-up. Conclusions: Simultaneous PRK followed by CXL seems to be a promising treatment capable of offering functional vision in patients with keratoconus. [ J Refract Surg . 2009;25:S807–S811.]