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Comparison of Outcomes Between Combined Transepithelial Photorefractive Keratectomy With and Without Accelerated Corneal Collagen Cross-Linking

A 1-Year Study

Lee, Hun MD*,†; Yong Kang, David Sung MD; Ha, Byoung Jin MD; Choi, Jin Young MD; Kim, Eung Kweon MD, PhD†,§; Seo, Kyoung Yul MD, PhD; Kim, Tae-im MD, PhD†,§

doi: 10.1097/ICO.0000000000001308
Clinical Science

Purpose: To investigate the effects of combined transepithelial photorefractive keratectomy (tPRK) and accelerated corneal collagen cross-linking (CXL) on visual acuity and refractive outcomes.

Methods: The medical records of 89 eyes (89 patients) undergoing combined tPRK and CXL (tPRK-CXL group) or tPRK alone (tPRK group) were retrospectively analyzed. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity, and manifest refraction spherical equivalent (MRSE) were evaluated preoperatively and 2 weeks, 1, 3, 6, and 12 months after surgery.

Results: At 2 weeks after surgery, the tPRK-CXL group had better UDVA than the tPRK group (0.97 ± 0.22 vs. 0.85 ± 0.22, P = 0.015). At 2 weeks and 1 month after surgery, the tPRK-CXL group had a significantly lower spherical error than the tPRK group (0.24 vs. 0.63 D, P = 0.017, for 2 weeks and 0.43 vs. 0.57 D, P = 0.019, for 1 month). At 12 months after surgery, the tPRK-CXL group had a lower spherical error and MRSE than the tPRK group (0.30 vs. 0.44 D, P < 0.001, for the spherical error and 0.17 vs. 0.31 D, P < 0.001, for the MRSE). Both groups had comparable predictability, efficacy, and safety indices at 12 months after surgery.

Conclusions: Combined tPRK and accelerated CXL demonstrated comparable predictability, efficacy, and safety compared with tPRK alone. Combined tPRK and CXL provides better UDVA in the early postoperative period and better refractive outcomes at 12 months postoperatively in terms of spherical error and MRSE.

*Department of Ophthalmology, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, South Korea;

Department of Ophthalmology, The Institute of Vision Research, Yonsei University College of Medicine, Seoul, South Korea;

Eyereum Eye Clinic, Seoul, South Korea; and

§Department of Ophthalmology, Corneal Dystrophy Research Institute, Yonsei University College of Medicine, Seoul, South Korea.

Reprints: Tae-im Kim, MD, PhD, Department of Ophthalmology, Yonsei University College of Medicine, 50-1 Yonseiro, Seodaemungu, Seoul 03722, Korea (e-mail:

Supported in part by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education, Science and Technology (NRF-2016R1A2B4009626) and by the research fund of Catholic Kwandong University International St. Mary's Hospital (CKURF-201601660001).

D. S. Yong Kang is consultant to Avedro Inc. The remaining authors have no funding or conflicts of interest to disclose.

Received January 26, 2017

Received in revised form May 24, 2017

Accepted June 15, 2017

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.