Combined wavefront-guided transepithelial photorefractive keratectomy and corneal crosslinking for visual rehabilitation in moderate keratoconus.

PURPOSE:To present 24-month results from the transepithelial photorefractive keratectomy (PRK)-corneal crosslinking (CXL) trial using simultaneous accelerated CXL and a new tissue-saving ocular wavefront-guided transepithelial PRK algorithm aiming to reverse visual loss in early-stage keratoconus without compromise to stabilization of disease progression. SETTING:Moorfields Eye Hospital, London, United Kingdom. DESIGN:Prospective case series. METHOD:Patients with progressive grades I to III keratoconus and logarithm of the minimum angle of resolution (logMAR) corrected distance vision acuity (CDVA) worse than 0.00 (20/20) were included. Consecutive matched historical controls treated only with accelerated CXL were the control group. The main outcome measure was change in logMAR CDVA. RESULTS:The study group comprised 47 eyes of 47 patients (mean age 24.6 years ± 3.8 [SD]). The CDVA improved from 0.28 ± 0.21 logMAR (20/60) preoperatively to 0.15 ± 0.14 logMAR (20/30) 24 months after transepithelial PRK-CXL (P < .001). Twelve eyes gained and 1 eye lost 2 lines or more of CDVA. The mean stromal ablation depth at the cone apex was 35 ± 15 μm. Significant reductions in the maximum keratometry (K) reading and coma were evident in topographic comparison maps. The controls (n = 47) had no significant changes in CDVA, higher-order aberrations, or K values. The mean K values in both groups were stable from 6 months after treatment. CONCLUSION:Ocular wavefront-guided transepithelial PRK-CXL resulted in significant gains in CDVA without compromising CXL efficacy over a 24-month follow-up.