Non-topography–guided PRK Combined With CXL for the Correction of Refractive Errors in Patients With Early Stage Keratoconus

Abstract

Original Article Ali Fadlallah, MD, MSc, MPH; Ali Dirani, MD, MSc, MPH; Elias Chelala, MD; Rafic Antonios, MD; George Cherfan, MD; Elias Jarade, MD To evaluate the safety and clinical outcome of combined non-topography–guided photorefractive keratectomy (PRK) and corneal collagen cross-linking (CXL) for the treatment of mild refractive errors in patients with early stage keratoconus. A retrospective, nonrandomized study of patients with early stage keratoconus (stage 1 or 2) who underwent simultaneous non-topography–guided PRK and CXL. All patients had at least 2 years of follow-up. Data were collected preoperatively and postoperatively at the 6-month, 1-year, and 2-year follow-up visit after combined non-topography–guided PRK and CXL. Seventy-nine patients (140 eyes) were included in the study. Combined non-topography–guided PRK and CXL induced a significant improvement in both visual acuity and refraction. Uncorrected distance visual acuity significantly improved from 0.39 ± 0.22 logMAR before combined non-topography–guided PRK and CXL to 0.12 ± 0.14 logMAR at the last follow-up visit (P <.001) and corrected distance visual acuity remained stable (0.035 ± 0.062 logMAR preoperatively vs 0.036 ± 0.058 logMAR postoperatively, P =.79). The mean spherical equivalent decreased from −1.78 ± 1.43 to −0.42 ± 0.60 diopters (D) (P <.001), and the mean cylinder decreased from 1.47 ± 1.10 to 0.83 ± 0.55 D (P <.001). At the last follow-up visit mean keratometry flat was 43.30 ± 1.75 vs 45.62 ± 1.72 D preoperatively (P = .03) and mean keratometry steep was 44.39 ± 3.14 vs 46.53 ± 2.13 D preoperatively (P = .02). Mean central corneal thickness decreased from 501.74 ± 13.11 to 475.93 ± 12.25 µm following combined non-topography–guided PRK and CXL (P < .001). No intraoperative complications occurred. Four eyes developed mild haze that responded well to a short course of topical steroids. No eye developed infectious keratitis. Combined non-topography–guided PRK and CXL is an effective and safe option for correcting mild refractive error and improving visual acuity in patients with early stable keratoconus. [J Refract Surg. 2014;30(10):688–693.] From Beirut Eye Specialist Hospital, Beirut, Lebanon (AF, AD, GC, EJ); Saint-Joseph University, Faculty of Medicine, Beirut, Lebanon (AF, AD, EC); Pierre et Marie Curie University, Sorbonne Universities, Paris, France (AF); American University of Beirut, faculty of Medicine, Beirut, Lebanon (RA); and Mediclinic, Dubai Mall, Dubai (EJ). The authors have no financial or proprietary interest in the materials presented herein. Drs. Fadlallah and Dirani contributed equally to this work and should be considered as equal first authors. AUTHOR CONTRIBUTIONS Study concept and design (AF, AD, EC, GC, EJ); data collection (AF, AD, RA, EJ); analysis and interpretation of data (AF, AD, EJ); drafting of the manuscript (AF, AD); critical revision of the manuscript (AF, AD, EC, RA, GC, EJ); statistical expertise (AF, AD); administrative, technical, or material support (AF); supervision (AD, EC, RA, GC, EJ) Correspondence: Elias Jarade, MD, Beirut Eye Specialist Hospital, Al-Mathaf square, P.O. Box 116-5311, Beirut, Lebanon. E-mail: ejarade@yahoo.com 10.3928/1081597X-20140903-02