ESCRS - FP02.07 - Prospective Multi-Parameter Propensity Score–Matched Analysis Of Corneal Haze Following Combined Versus Sequential Customized Transepithelial Prk With Accelerated Corneal Cross-Linking.

Prospective Multi-Parameter Propensity Score–Matched Analysis Of Corneal Haze Following Combined Versus Sequential Customized Transepithelial Prk With Accelerated Corneal Cross-Linking.

Published 2026 - 44th Congress of the ESCRS

Reference: FP02.07 | Type: Free paper | DOI: 10.82333/qjfb-2q37

Authors: Prof. Dr Shady Awwad* 1 , Dr Sarah Abou Daher 1 , Dr Jad F. Assaf 2 , A/Prof. Farhad Hafezi 3 , Dr Hadi Chebaro 1 , Dr Yara Bteich 1 , Dr Karim Kozhaya 4

1Ophthalmology,American University of Beirut,Beirut ,Lebanon, 2Ophthalmology,OHSU,Portland,United States, 3Ophthalmology,ELZA institute,Zurich,Switzerland, 4Ophthalmology,Baylor,Houston,United States

Purpose

To objectively evaluate stromal haze and refractive and tomographic results in eyes undergoing combined versus sequential customized transepithelial PRK (TransPRK) with accelerated corneal cross-linking (A-CXL)

Setting

American University of Beirut Medical Center.

Methods

A prospective observational study of 118 eyes undergoing customized TransPRK either with combined A-CXL (n=90) or after prior A-CXL (n=28). All cases were performed by the same surgeon using the same laser platform (SCHWIND Amaris).  No mitomycin C (MMC) was used in the combined group. Customized ablation targeted mainly higher-order aberrations (HOAs). PSM matched age, sex, corneal thickness, Kmax, Kmean, and total coma. Baseline and 1,3,6, and 12 months assessments included uncorrected and distance corrected visual acuity (UDVA and CDVA), manifest refraction, tomography, corneal HOAs, and optical coherence tomography (OCT). Stromal haze was quantified on OCT in grayscale units using a validated machine-learning algorithm.

Results

After propensity score matching, 27 eyes were included per group. At 12 months, both groups gained 2 lines of CDVA with no significant between-group difference. Kmax decreased significantly in both groups (combined: 51.94±4.96 D to 48.91±3.86 D; sequential: 49.37±2.90 D to 47.49±3.47 D; both P=0.001), with comparable flattening between groups. Total corneal coma improved similarly in both groups (0.5 D reduction; P<0.001 within groups; no between-group difference). OCT-derived reflectivity increased postoperatively in both groups  the combined group showed an earlier anterior rise, whereas the sequential group demonstrated higher subepithelial reflectivity at 6 months; by 12 months, reflectivity profiles converged in both groups.

Conclusions

Both sequential and combined customized TransPRK yielded similar stromal haze profiles and visual, tomographic, and aberrometric outcomes.