Comparative Analysis of Combined Topography-Guided Photorefractive Keratectomy and Corneal Crosslinking in Progressive Versus Stable Keratoconus

To perform a comparative analysis of visual, refractive, and tomographic outcomes of combined topography-guided photorefractive keratectomy (TG-PRK) and corneal crosslinking (CXL) in patients with progressive versus stable keratoconus. Longitudinal retrospective case-control study. Patients with ker...

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Bibliographic Details
Published in:Cornea Vol. 44; no. 8; p. 983
Main Authors: Gil, Pedro, Gil, João Quadrado, Dias, Margarida, Cunha, Bruna, Alves, Nuno, Rosa, Andreia, Murta, Joaquim
Format: Journal Article
Language:English
Published: United States 01.08.2025
Subjects:
Adolescent
Adult
Case-Control Studies
Collagen - metabolism
Corneal Stroma - metabolism
Corneal Topography - methods
Cross-Linking Reagents - therapeutic use
Disease Progression
Female
Follow-Up Studies
Humans
Keratoconus - diagnosis
Keratoconus - drug therapy
Keratoconus - metabolism
Keratoconus - physiopathology
Keratoconus - surgery
Keratoconus - therapy
Lasers, Excimer - therapeutic use
Male
Photochemotherapy - methods
Photorefractive Keratectomy - methods
Photosensitizing Agents - therapeutic use
Refraction, Ocular - physiology
Retrospective Studies
Riboflavin - therapeutic use
Surgery, Computer-Assisted - methods
Ultraviolet Rays
Visual Acuity - physiology
Young Adult
corneal crosslinking
progression
keratoconus
Athens
photorefractive keratectomy
ISSN:1536-4798, 1536-4798
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Summary:To perform a comparative analysis of visual, refractive, and tomographic outcomes of combined topography-guided photorefractive keratectomy (TG-PRK) and corneal crosslinking (CXL) in patients with progressive versus stable keratoconus. Longitudinal retrospective case-control study. Patients with keratoconus submitted to simultaneous TG-PRK and CXL were included, with a minimum follow-up of 12 months up to 3 years. According to predefined disease progression criteria, patients were considered as progressive or stable. A total of 101 eyes from 93 patients were included, 62 considered progressive and 39 stable keratoconus. All baseline characteristics were similar between groups, except for age at surgery (progressive: 23.40 ± 4.22 years; stable: 35.97 ± 9.09; P < 0.001). Logarithm of the minimum angle of resolution CDVA improved significantly in progressive (baseline: 0.48 ± 0.24; 12 months: 0.33 ± 0.29; P < 0.001) and stable (baseline: 0.51 ± 0.24; 12 months: 0.28 ± 0.21; P < 0.001) patients, with no differences between groups. Maximum keratometry decreased significantly in progressive (baseline: 59.18 ± 5.63 diopters; 12 months: 54.73 ± 5.95; P < 0.001) and stable (baseline: 57.77 ± 5.02; 12 months: 53.59 ± 4.20; P < 0.001) patients, with no differences between groups. Index of surface variance significantly improved in progressive (baseline: 109.18 ± 31.74 diopters; 12 months: 94.11 ± 34.11; P < 0.001) and stable (baseline: 102.87 ± 29.52; 12 months: 86.95 ± 27.21; P < 0.001) patients, with no differences between groups. Other tomographic outcomes were also similar between groups. Pachymetry significantly decreased after surgery but remained stable throughout the follow-up. Combined TG-PRK and CXL is a safe and effective procedure for improving CDVA and regularizing the cornea, with comparable visual, refractive, and tomographic outcomes in both progressive and stable keratoconus. Combined TG-PRK and CXL may be added to the armamentarium of therapeutic tools for visual rehabilitation in patients with stable keratoconus.
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ISSN:1536-4798
1536-4798
DOI:10.1097/ICO.0000000000003653