Partial Topography-guided Photorefractive Keratectomy Followed by Corneal Cross Linking in the Management of Progressive Keratoconus: Our Initial Ten-month Results.

The aim was to assess the results achieved in keratoconic corneas submitted to the combined partial topography-guided photorefractive keratectomy (TG-PRK) and corneal cross linking (CXL) procedure performed on the same day. Four patients underwent this treatment of one eye. Corneal epithelium removal was performed by 50-micron phototherapeutic keratectomy. Then, partial TG-PRK laser treatment was applied (Wavelight Allegretto, Eye Q, 400Hz), followed by corneal collagen cross-linking (CXL, 3 mW/cm2) for 30 minutes using 0.1% topical riboflavin solution. Outcome measurements included uncorrected distance visual acuity (UCDVA), best spectacle corrected distance visual acuity (BSCDVA), manifest refraction spherical equivalent, keratometry, corneal high order aberration values, and corneal tomography. At the end of 10-month follow up, all eyes showed improvement in BSCDVA of 1-5 lines on Snellen chart. All other investigated parameters showed significant improvement as well. One eye showed some topographic improvement, but no improvement in UCDVA. No corneal haze, prolonged epithelial healing or endothelial cell loss occurred. During 10-month follow up, the same-day combined TG-PRK and CXL appeared to offer tomographic improvement and better visual acuity in keratoconus patients.