Visual and refractive outcomes of photorefractive keratectomy after corneal collagen cross-linking in patients with keratoconus

Purpose: to evaluate the refractive and visual outcomes of photorefractive keratectomy (PRK) after corneal collagen cross-linking (CXL) in patients with keratoconus (KCN).Methods: in this interventional case series, sequential CXL and PRK was performed for patients with mild to moderate KCN. All eyes underwent conventional CXL. PRK was performed 3-6 months later. Uncorrected and best-corrected visual acuity, manifest refraction and mean keratometry were evaluated before and 3 and 6 months after PRK.Results: eighteen eyes of 18 patients (10 female and 8 male) were included. The mean age was 31.05 ± 3.43 years (27-38) and the mean interval between CXL and PRK was 4.5 months (3-6). Mean spherical equivalent decreased from -3.18 ± 0.55 diopter (D) to -1.52 ± 0.43 D at 3 months and -0.77 ± 0.36 D at 6 months postoperatively (P<0.001). Uncorrected visual acuity (UCVA) improved from 0.56 ± 0.14 logarithm of minimum angle of resolution (LogMAR) to 0.27 ± 0.09 LogMAR and 0.13 ± 0.07 LogMAR at 3 and 6 postoperative month, respectively.Conclusion: Our short-term results showed that sequential CXL and PRK is safe and effective for vision correction in patients with mild to moderate KCN.