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Photorefractive keratectomy for the correction of residual mild refractive errors after intracorneal ring segment implantation and corneal collagen cross-linking in keratoconus

Poster Details

First Author: A.Fadlallah LEBANON

Co Author(s):    A. Dirani   Z. Syed   Z. Khoueir   G. Cherfan   F. Abi Nader   E. Jarade

Abstract Details


To evaluate the safety and clinical outcome of photorefractive Keratectomy (PRK) for the treatment of residual mild refractive errors 6 months after sequential Intracorneal Ring segments (ICRS) and corneal collagen UVA cross-linking (CXL) in stable keratoconus.


University Hospital, Beirut Eye Specialist Hospital


A retrospective study examined the results of a 3-step (ICRS-CXL)/PRK in 6 eyes of 4 patients with mild to moderate keratoconus. The two procedures (ICRS-CXL) were performed sequentially at an interval of 4 weeks and PRK was performed at least 6 months after CXL. Data were collected preoperatively, at the 6-month follow-up visit after sequential ICRS-CXL, and at the 6-month follow-up visit after PRK.


ICRS-CXL induced a significant decrease in keratometry, increase in visual acuity and decrease in refraction. At 6-month follow-up after ICRS-CXL, mean Kflat was 44.12ḟ2.23 D vs. 46.23ḟ2.07 D preoperatively (p=0.01) and mean Ksteep was 47.37ḟ3.07 D vs. 50.29ḟ2.23 D preoperatively (p=0.01). Uncorrected distance visual acuity (UCVA) significantly improved from 1.26 ±0.38 logMAR before ICRS-CXL to 0.49 ±0.12 logMAR 6 months after (p = 0.028) and corrected distance visual acuity (CDVA) significantly improved from 0.41 ±0.11 logMAR to 0.16ḟ0.07 logMAR (p=0.01). The mean spherical error decreased from -5.45 ±2.37 D to -2.5 ±1.41 D (p=0.01), and the mean cylinder from 4.08 ±1.1.36 D to 2.25 ±1.49 D (p=0.001). At 6-month post PRK, UCVA improved significantly to 0.15ḟ0.05 logMAR and the CDVA was 0.12 ±0.05 logMAR. The safety and efficacy indices of PRK after ICRS-CXL were1.11ḟ0.14 and 1.04ḟ0.15 respectively. The mean spherical error decreased significantly to -0.87 ±0.46 D (p=0.02), and the mean cylinder decreased significantly to 0.91 ±0.20 D (p=0.04). No intraoperative or postoperative complications occurred.


Photorefractive keratectomy after sequential Intracorneal Ring Segments and corneal collagen cross-linking is an effective and safe option for correcting residual refractive error and improving visual acuity in patients with moderate keratoconus.

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