Biomechanical Stability After Corneal Wavefront-Guided Trans Photorefractive Keratectomy And Accelerated Cross-Linking In Non-Progressive Mild Keratoconus

To evaluate the long-term biomechanical stability, safety, and efficacy of simultaneous corneal wavefront-guided transepithelial photorefractive keratectomy (CW-TransPRK) with accelerated corneal cross-linking (CXL) in patients with non-progressive mild keratoconus. The study assessed visual acuity, refractive accuracy, corneal topography, biomechanics, epithelial remodeling, and disease progression using the Consensus-Based Core and ABCDE classification criteria over a 12-month follow-up period.

A prospective, interventional, single-center study conducted at Instituto de Oftalmología Conde de Valenciana, Mexico City.

A total of 38 eyes from 19 patients with non-progressive mild keratoconus underwent CW-TransPRK with accelerated CXL and were followed for 12 months. Evaluations included uncorrected (UDVA) and corrected distance visual acuity (CDVA), refractive accuracy, corneal tomography, biomechanics, and epithelial remodeling. Disease progression was monitored using the Consensus-Based Core and ABCDE criteria. Biomechanical stability was assessed using stress-strain index (SSI) and stiffness parameter (SP-A1).

At 12 months, UDVA significantly improved from 0.80 ± 0.36 LogMAR to -0.03 ± 0.10 LogMAR (p < 0.0001), with 87% of eyes achieving 20/20 and all reaching 20/40 or better. CDVA improved (p < 0.0001) with no loss of Snellen lines. 61% of eyes were within ±0.50 D, and 89% within ±1.00 D of target refraction. Biomechanical resistance increased, with SSI significantly improving (p < 0.0001) and SP-A1 stabilizing after the first week. No cases of keratoconus progression were observed. Epithelial mapping showed regional thickening, primarily in nasal and temporal areas.

CW-TransPRK with accelerated CXL was found to be safe and effective, significantly improving visual acuity and refractive accuracy while maintaining biomechanical stability and preventing keratoconus progression. The observed biomechanical improvements confirm the structural reinforcement effect of the treatment, supporting its role as a viable intervention for non-progressive mild keratoconus.