Simultaneous wavefront-guided photorefractive keratectomy and corneal collagen crosslinking after intrastromal corneal ring segment implantation for keratoconus.

Purpose: To study the results of simultaneous photorefractive keratectomy (PRK) and corneal collagen crosslinking (CXL) in keratoconus after previous intrastromal corneal ring segment (ICRS) implantation.

Setting: Enaim Laser Center, Jerusalem, Israel.

Design: Case series.

Methods: This study comprised patients with moderate keratoconus who had previous Intacs ICRS implantation with the Intralase laser at least 6 months before PRK-CXL. Wavefront-guided PRK and ultraviolet-A CXL were performed simultaneously. Refraction, uncorrected (UDVA) and corrected (CDVA) distance visual acuities, keratometry (K) values, endothelial cell count (ECC), pachymetry, corneal resistance factor (CRF), and corneal hysteresis (CH) were assessed 3, 6, and 12 months postoperatively.

Results: Twelve months after PRK-CXL, the mean decimal UDVA improved significantly from 0.20 ± 0.12 (SD) to 0.55 ± 0.15 (P<.01). The mean decimal CDVA improved from 0.58 ± 0.13 to 0.77 ± 0.17 (P=.01). The mean cylinder decreased from -3.60 ± 1.70 to -1.30 ± 1.10 diopters (D) (P<.001). The mean apex K decreased from 50.91 ± 5.50 D to 46.61 ± 4.52 D (P<.005). The other corneal parameters did not change significantly after treatment. No significant difference was found between the 6-month and 12-month results. No patient lost lines of CDVA. Mild haze remained in 11.1% of eyes 12 months after treatment.

Conclusions: Simultaneous wavefront-guided PRK and CXL for keratoconus after ICRS implantation was safe and effective. It significantly improved the UDVA, CDVA, and central K value, and consequently the visual function, of patients with moderate keratoconus.