Simultaneous Topography-Guided Photorefractive Keratectomy Followed by Corneal Collagen Cross-linking for Keratoconus

Purpose To present the long-term results after simultaneous photorefractive keratectomy followed by corneal collagen cross-linking for keratoconus. Design Prospective, interventional, consecutive case series. Methods In this study, 26 patients (31 eyes) with progressive keratoconus were included. All patients underwent customized topography-guided photorefractive keratectomy immediately followed by corneal collagen cross-linking with the use of riboflavin and ultraviolet A irradiation. Epithelium was removed by transepithelial phototherapeutic keratectomy in all cases. Results Mean follow-up was 19.53 ± 3.97 months (range, 12 to 25 months). Mean preoperative spherical equivalent was −2.3 ± 2.8 diopters (D), whereas at the last follow-up examination, it was significantly ( P < .001) reduced to −1.08 ± 2.41 D. Logarithm of the minimal angle of resolution uncorrected and best-corrected visual acuity were reduced significantly by 0.46 and 0.084 ( P < .001), respectively, at the last follow-up examination. Finally, mean steep and flat keratometry readings were reduced by 2.35 ( P < .001) and 1.18 ( P = .013) at the last follow-up examination. Conclusions Simultaneous photorefractive keratectomy followed by corneal collagen cross-linking seems to be a promising treatment alternative in our series of keratoconic patients.