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Non topo-guided photorefractive keratectomy combined with corneal collagen cross-linking for the correction of refractive errors in patients with early stage keratoconus

Poster Details

First Author: A.Dirani LEBANON

Co Author(s):    A. Fadlallah   Z. Khoueir   E. Jarade   F. Abi Nader   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.


University Hospital, Beirut Eye Speciality Hospital


A retrospective study examined the records of patients with early stage keratoconus (forme fruste or stage 1) 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 Non topo-guided PRK-CXL, and at later follow up visits.


73 patients (123 eyes) were included in the study. The mean follow up period was 9 months (range from 6 to 18 months) . Combined NTG-PRK and CXL induced a significant increase in visual acuity and decrease in refraction. Uncorrected distance visual acuity (UCVA) significantly improved from 0.44 ±0.337 logMAR before Combined NTG-PRK/CXL to 0.08 ±0.12 logMAR at last follow up visit (p = 0.01) and corrected distance visual acuity (CDVA) remained stable (0.053±0.09 logMAR preoperatively vs 0.04 ±0.05 logMAR postoperatively, p=0.405). The mean spherical equivalence decreased from -2.5 ±1.78 D to -0.85 ±0.67 D (p=0.01), and the mean cylinder from 2.43±0.88 D to 0.90 ±0.53 D (p=0.01). At last follow up visit mean Kflat was 43.5 ±1.73 D vs. 46.23ḟ1.58 D preoperatively (p=0.01) and mean Ksteep was 45.14ḟ1.87 D vs. 47.24 ḟ1.73 D preoperatively (p=0.01). Mean central corneal decreased from 520.48 ±25.47 to 479.67 ±38.58 um post Combined NTG-PRK and CXL (p=0.01). No intraoperative complications occurred. 4 eyes developed mild haze that responded well to a short course of topical steroids. 2 eyes developed infectious keratitis that was treated properly with topical antibiotics.


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.

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