Non-topography-guided photorefractive keratectomy for the correction of residual mild refractive errors after ICRS implantation and CXL in keratoconus.

Purpose: To evaluate the safety and clinical outcomes of non-topography-guided photorefractive keratectomy (PRK) for the treatment of residual mild refractive errors 6 months after sequential intracorneal ring segment (ICRS) implantation and corneal collagen cross-linking (CXL) in stable keratoconus.

Methods: This retrospective study included 17 eyes of 14 patients with mild to moderate keratoconus. The ICRS implantation and CXL were performed sequentially with a 4-week interval and non-topography-guided PRK was performed at least 6 months after CXL. Data were collected preoperatively and at the 6-month follow-up visits.

Results: ICRS implantation and CXL induced a significant decrease in keratometry and refraction and an increase in visual acuity. At the 6-month follow-up after ICRS implantation and CXL, uncorrected and corrected distance visual acuity (UDVA and CDVA) significantly improved from 1.17 ± 0.38 and 0.44 ± 0.09 logMAR preoperatively to 0.45 ± 0.11 and 0.17 ± 0.08 logMAR (P = .001) postoperatively, respectively. The mean spherical error decreased from -5.45 ± 1.64 to -2.57 ± 1.15 D (P = .01) and the mean cylinder from 3.86 ± 1.15 to 2.13 ± 1.11 D (P = .01). At the 6-month follow-up after PRK, UDVA significantly improved to 0.18 ± 0.06 logMAR and CDVA was 0.15 ± 0.05 logMAR. The mean spherical error and mean cylinder significantly decreased to -1.10 ± 0.41 D (P = .02) and 0.98 ± 0.37 D (P = .046), respectively. No intraoperative or postoperative complications occurred.

Conclusions: At the 6-month follow-up, non-topography-guided PRK after ICRS implantation and CXL was found to be an effective and safe option for correcting residual refractive error and improving visual acuity in patients with moderate keratoconus.