Comparison Of Sequential Topography Guided Photorefractive Keratectomy And Transepithelial Corneal Collagen Cross Linking Versus Simultaneous Topography Guided Photorefractive Keratectomy And Corneal Collagen Crosslinking.
Published 2026 - 44th Congress of the ESCRS
Reference: FP02.04 | Type: Free paper | DOI: 10.82333/xjx7-b003
Authors: Dr Deeksha Sharma* 1 , A/Prof. Chintan Malhotra 1 , A/Prof. Amit Gupta 1 , Dr Lekha Chandel 1 , Dr Vipasha Sharma 1
1Advanced Eye Centre Ophthalmology,Postgraduate Institute of Medical Education and Research Chandigarh,Chandigarh,India
Purpose
To compare 6-month visual, tomographic, and safety outcomes of a sequential approach of
topography-guided PRK (TG-PRK) followed by accelerated transepithelial corneal crosslinking
(Acc-TECXL) versus simultaneous TG-PRK with accelerated epithelium-off CXL in progressive
keratoconus.
Setting
Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh India
Methods
This prospective randomized study included 30 eyes with progressive stage 1–2 keratoconus (age
>18 years; minimum corneal thickness >450 µm). All eyes underwent alcohol-assisted epithelial
removal followed by TG-PRK (maximum ablation depth 60 µm) using the Wavelight EX500 excimer
laser. Ten eyes underwent same-day accelerated epithelium-off CXL (simultaneous group), while
20 eyes underwent Acc-TECXL 4 weeks after TG-PRK (sequential group). Outcome measures at 6
months included uncorrected and corrected distance visual acuity (UDVA, CDVA), corneal
topographic parameters, demarcation line depth, corneal haze (densitometry), endothelial cell
density, and epithelial healing.
Results
In the sequential group, significant improvement in mean decimal UDVA (0.49 ± 0.21) and CDVA
(0.90 ± 0.16) was observed as early as 1 month from baseline. In the simultaneous group,
comparable improvements in UDVA (0.49 ± 0.13) and CDVA (0.93 ± 0.15) occurred at 3 months.
Although the simultaneous group demonstrated a deeper central demarcation line, it was
associated with increased corneal haze, greater endothelial cell loss, and delayed epithelial healing
in 50% of eyes. No delayed epithelial healing was observed in the sequential group.
Conclusions
Both techniques effectively stabilise and regularise the cornea in early keratoconus. The sequential
approach offers advantages of faster epithelial healing, earlier visual recovery, and reduced
postoperative haze.