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Combined photorefractive keratectomy and high energy accelerated cross-linking: standard cross-linking after intrastromal corneal ring implantation for keratoconus

Poster Details

First Author: J.Arbelaez OMAN

Co Author(s):    M. Arbelaez                    

Abstract Details


To determine the safety, efficacy and stability of photorefractive keratectomy (PRK)/trans-PRK and simultaneous standard/accelerated corneal crosslinking after Intrastromal corneal ring segment (ICRS) implantation in patients with keratoconus.


Muscat Eye Laser Center, Muscat, Oman


We included patients with early keratoconus who received an ICRS (Keraring, Belo Horizonte, Brazil) 1,6 years in average before enrolment. PRK (or Trans-PRK) was performed with the Amaris 750S (Schwind) using customized profiles, optical zones between 5.25 to 6.7 mm, and ablations between 22 to 85µm. Next, 9 eyes with high energy accelerated crosslinking XTRA (Avedro), and 7 eyes standard Crosslinking KXL at the same day. Follow-up was performed at months 3, 6, and 3 years in average including; UCVA, BCVA, refraction, keratometry, placido topography (KeratronScout, Optikon), and Scheimpflug imaging (Sirius, CSO Inc. and Pentacam, Oculus).


This study included 16 eyes (12 patients) of mean age 31.8 ± 8.3 years (range 23-50 years). 19% of patients had stage 1 keratoconus whereas 56% had stage 2 and 25% stage 3. At 2,9 years of follow up (SD 1.06, min 1.1 max4.6) as compared to pre-operatively (post ICR) there was a significant improvement in mean UCVA (0.32 vs 0.56 ; p0.000), BCVA (0.65 vs 0.76; p=0.007), cylinder (-2.03 vs -1.20 D; p=0.031). No statistically difference found on the sphere (-0.60 vs +0.29 D; p=0.134). Although Kmax increase, the difference was not statistically significant (49.73 vs 50.15 D; p=0.301).


Simultaneous PRK/Trans-PRK and XTRA or KXL following ICRS implantation appears to be a safe and effective treatment that helps to improve functional vision in patients with keratoconus and shows a long-term stability.

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