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Visual rehabilitation of patients with mild to moderate keratoconus with non topo-guided photorefractive keratectomy combined corneal collagen cross-linking

Poster Details

First Author: E.Chelala LEBANON

Co Author(s):    A. Fadlallah   A. Dirani   R. Antonios   E. Jarade   G. Cherfan  

Abstract Details


To evaluate the safety and clinical outcome of combined non-topo-guided photorefractive Keratectomy (NTG-PRK) and corneal collagen cross-linking (CXL) for the treatment of mild refractive errors in patients with early stage keratoconus.


Beirut Eye Specialist Hospital


A retrospective study examined the records of patients with early stage keratoconus (forme fruste or stage 1 or 2) who underwent NTG-PRK and CXL. The two procedures were performed at the same day at Beirut Eye speciality Hospital. Data were collected preoperatively, at the 6-month follow-up visit after combined NTG-PRK/CXL, and at 1 year and 2 years follow up visits.


79 patients (140 eyes) were included in the study. All patients had at least 2 years follow-up. Combined NTG-PRK and CXL induced a significant increase in visual acuity and decrease in refraction. Uncorrected distance visual acuity (UCVA) significantly improved from 0.45±0.18 logMAR before Combined NTG-PRK/CXL to 0.78±0.17 logMAR at last follow up visit (p <0.001) and corrected distance visual acuity (CDVA) remained stable (0.035±0.062 logMAR preoperatively vs 0.036±0.058 logMAR postoperatively, p=0.79). The mean spherical equivalence decreased from -1.78±1.43 D to -0.42±0.60 D (p <0.001), and the mean cylinder from 1.47±1.10D to 0.83±0.55D (p <0.001). At last follow up visit mean Kflat was 45.62±1.72D vs. 43.30±1.75D preoperatively (p=0.03) and mean Ksteep was 46.53±2.13D vs. 44.39±3.14D preoperatively (p=0.02). Mean central corneal decreased from 44.39±3.14um to 470.65±33.45um post Combined NTG-PRK and CXL (p<0.001). No intraoperative complications occurred. Four eyes developed mild haze that responded well to a short course of topical steroids. No eye developed infectious keratitis.


Non topo-guided Photorefractive keratectomy combined to corneal collagen cross-linking is an effective and safe option for correcting mild refractive error and improving visual acuity in patients with early keratoconus. FINANCIAL INTEREST: NONE

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