Outcomes of simultaneous photorefractive keratectomy and collagen crosslinking

Objective: To report the outcomes and complications of combined photorefractive keratectomy (PRK) and collagen crosslinking (CXL). Design: A retrospective cohort study of consecutive patients undergoing combined PRK-CXL between 2011 and 2013 at Care Laser, Inc, Tel Aviv, Israel. Participants: Ninety-eight eyes of 56 patients were included. Only patients without keratoconus were included. Methods: Data were collected from the patients’ files and imaging devices. Main outcome measures were corrected and uncorrected distance visual acuity (CDVA/UDVA); spherical equivalent (SE); refractive, keratometric, and pachymetric stability; and the occurrence of postoperative complications. Results: Mean age was 27.69 ± 6.6 years. UDVA improved from 1.38 ± 0.60 to 0.15 ± 0.24 logMAR (p < 0.001). SE improved from −4.45 ± 2.87 diopter (D) to +0.20 ± 0.90 D (p < 0.001), and 69% of the patients were within ±0.50 D from emmetropia. Four eyes had significant corneal haze; of them 3 eyes lost more than 2 Snellen lines. No cases of corneal ectasia were recorded. Conclusions: In our cohort PRK-CXL achieved significantly improved UDVA and SE compared to baseline. Corneal haze was a significant complication. Refractive results were less accurate than published for patients undergoing PRK procedures. Although no cases of corneal ectasia were seen, given the rarity of such complication, the added benefit of CXL remains to be proven.