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Simultaneous Topography-Guided Photorefractive Keratectomy and Accelerated Corneal Collagen Cross-Linking for Keratoconus

Sakla, Hani MD, PhD; Altroudi, Wassim MD; Munoz, Gonzalo MD, PhD; Sakla, Yousef IB

doi: 10.1097/ICO.0000000000000843
Clinical Science

Purpose: To study the evolution of visual and refractive outcomes through the first year after simultaneous topography-guided photorefractive keratectomy (t-PRK) and corneal collagen cross-linking (CXL) in keratoconus.

Methods: This retrospective case series included 85 eyes of 66 patients with a mean age of 26.3 ± 5.7 years, which underwent simultaneous t-PRK with accelerated CXL. Patients were examined for uncorrected distance visual acuity and corrected distance visual acuity (CDVA), flat and steep keratometry readings, and manifest refraction spherical equivalent at 1, 3, 6, and 12 months.

Results: At 12 months, all study parameters demonstrated a statistically significant improvement with uncorrected distance visual acuity 0.46 ± 0.49 logMAR (vs. 0.86 ± 0.39 logMAR preoperatively), CDVA 0.11 ± 0.12 logMAR (vs. 0.41 ± 0.27 logMAR preoperatively), manifest refraction spherical equivalent −2.80 ± 4.47 D (vs. −4.51 ± 4.68 D preoperatively), flat keratometry 43.84 ± 3.24 D (vs. 44.61 ± 3.12 D preoperatively), and steep keratometry 46.05 ± 3.94 D (vs. 48.10 ± 3.68 D preoperatively). Although 90.6% eyes gained 1 or more lines of CDVA, no eyes lost any lines of CDVA. In all, 37.6% of the eyes demonstrated an improvement of 4 or more lines of CDVA with a maximum improvement of 11 lines of CDVA in 1 eye.

Conclusions: Simultaneous t-PRK with accelerated CXL improved the spherocylindrical refraction and visual function of keratoconus eyes, and the outcomes were stable through 12 months' follow-up. Future studies with longer follow-up and larger data set are necessary to validate the results of the current study and evaluate the long-term safety and efficacy.

Ebsaar Eye Surgery Center, Dubai, United Arab Emirates.

Reprints: Hani Sakla, MD, PhD, Ebsaar Eye Surgery Center, P.O. Box 333397, Dubai, United Arab Emirates (e-mail:

The authors have no funding or conflicts of interest to disclose.

Received August 20, 2015

Received in revised form February 24, 2016

Accepted February 25, 2016

Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.