Combined photorefractive keratectomy and corneal collagen cross-linking for treatment of keratoconus: a 2-year follow-up study

Abstract

Background: Corneal collagen cross-linking (CXL) is considered an effective procedure for slowing down or eliminating the progression of keratoconus. New techniques, in combination with CXL, have been proposed to stop the evolution of keratoconus and improve the visual function.

Objective: To evaluate the effectiveness of combined photorefractive keratectomy (PRK) with mitomycin-C (MMC) application and CXL in the management of grade 1-2 keratoconus over a 2-year follow-up.

Methods: Fifteen eyes underwent topography-guided PRK with 0.02% MMC application immediately followed by standard CXL.

Results: Best corrected visual acuity improved from 0.15 ± 0.11 logMAR to 0.08 ± 0.09 logMAR at 24 months (p < 0.0001) in treated eyes. Mean steepest meridian keratometry reduced from 48.79 ± 3.22 D at baseline to 46.16 ± 3.11 D at 24 months (p < 0.0001). Mean flattest meridian keratometry reduced from 45.18 ± 2.17 D preoperatively to 44.35 ± 2.19 D at 24 months (p < 0.0001).

Conclusion: Simultaneous topography-guided PRK with MMC 0.02% application and standard CXL is a safe, promising and effective procedure in the treatment of mild and moderate keratoconus.

Keywords: corneal collagen crosslinking; keratoconus; mitomycin C; photorefractive keratectomy; refractive surgery.

Figure 1.

Preoperative and postoperative uncorrected distance visual acuity (UCVA) and best corrected distance visual acuity (BCVA) in logMAR.

Figure 2.

Refractive outcomes in diopters (D) at baseline and during the follow-up period for mean sphere, mean cylinder and mean spherical equivalent (SE).

Figure 3.

Topographic corneal outcomes in diopters (D) at baseline and during the postoperative follow-up for steepest keratometry (Ks), flattest keratometry (Kf), mean keratometry (Km) and corneal astigmatism (CA).