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Simultaneous photorefractive keratectomy and collagen cross-linking in patients with an increased risk for post-refractive surgery corneal ectasia

Poster Details

First Author: O.Ohana ISRAEL

Co Author(s):    Y. Domnitz   G. Munzer   E. Cohen   D. Varssano     

Abstract Details


To report the surgical outcomes and complication profile in patients with an increased surgical risk for post-photorefractive keratectomy (PRK) ectasia undergoing simultaneous PRK and collagen crosslinking (CXL).


Care laser, Tel-Aviv, Israel. A private refractive surgery clinic.


A Retrospective interventional case series.Patients classified as having high-risk for post-refractive surgery corneal ectasia by the surgeon were included. Patients were treated with PRK immediately followed by CXL with UV/riboflavin (PRK-CXL). Main outcomes were safety, uncorrected distance visual acuity (UDVA), spherical equivalent (SE), refractive-, keratometric- and pachymetric- stability and the occurrence of postoperative complications such as haze and corneal ectasia.


The study evaluated 136 eyes of 77 patients treated with PRK-CXL. Mean age was 27.69 ± 6.6 years. Mean Follow-up was 367.16 ± 196.5 days (range 96-778). Pre-operative UDVA was 1.38 ± 0.61 LogMAR and improved significantly to 0.13 ± 0.21 LogMAR at the last follow up (P<0.001). Best-corrected visual acuity was 0.06 ± 0.09 LogMAR pre-operatively, which remained stable post-operatively at 0.07 ± 0.10 LogMAR, not a statistically significant difference (P = 0.28). Pre-operative mean SE was 4.49 ± 2.81 Diopter (D), which was significantly reduced to -0.02 ± 1.01 D (P<0.001). Pre-operative Central Corneal Thickness (CCT) was 495.52 ± 40.85 micron and was significantly reduced to 371.48 ± 47.56 micron post-operatively (P<0.001). CCT remained stable throughout follow up. At the last follow up 69.9% of the patients were within ±0.50D from emmetropia and 88.2% were within ±1.00D from emmetropia. Four eyes had significant corneal haze (grades 3 and 4). No corneal ectsia cases were seen during follow up.


PRK-CXL in eyes with increased risk for developing post-refractive ectasia but without keratoconus seems to be a safe and effective procedure, providing predictable, stable, refractive results. Haze is a clinically significant complication. FINANCIAL INTEREST: NONE

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