Long-Term Follow-Up of Combined Photorefractive Keratectomy and Corneal Crosslinking in Keratoconus Suspects

Purpose: To present the long-term outcomes of photorefractive keratectomy (PRK) combined with accelerated corneal cross-linking (CXL) for refractive error correction in a series of keratoconus suspects. Setting: University practice. Design: Retrospective case series. Methods: A series of patients with topographic findings suspicious for keratoconus underwent simultaneous PRK and prophylactic accelerated CXL (5 minutes with intensity of 18 mW/cm(2)) for the correction of their refractive error. The results were recorded for more than 4 years postoperatively. Results: Ten eyes of 5 patients were included. Mean follow-up was 58.2 months (range from 54 to 62 months). Mean age at presentation was 25 years (range from 22 to 32 years). Mean spherical equivalent (SE) refraction was -2.76 (standard deviation [SD] 0.97D, range from -1.25 to -4.00 diopters [D]), while mean central corneal thickness was 511 mu m (SD 13 mu m, range from 485 to 536 mu m). At last, follow-up 9 out of 10 eyes had SE refraction within +/- 0.50D and all eyes had SE within +/- 1.00D. None of the eyes lost any line of corrected distance visual acuity (CDVA), whereas 1 eye gained one line of CDVA. All eyes demonstrated stability of their results during the follow-up period. Conclusion: Simultaneous PRK followed by prophylactic accelerated CXL (PRK plus) appeared to be a safe and effective option for the correction of the refractive error in this series of keratoconus suspect patients, without compromising corneal stability for up to 5 years postoperatively.