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Purpose: To demonstrate clinical outcomes of epithelium-off corneal cross-linking (CXL) in combination with wavefrontguided photorefractive keratectomy (PRK) for the treatment of keratoconuns. Materials and methods: Total, 28 keratoconic eyes of 21 patients were included. The Sirius Wavefront Analyzer (SCHWIND eye-tech-solutions GmbH and Co. KG) was used to evaluate the high-order aberrations (HOAs). The coupled Amaris 750S excimer laser then performed a PRK of no more than 40 μm using the measured HOA. The CXL was then carried out respecting the standard of 400 μm of corneal thickness. Results: The average age was 32 (15–48) years. Uncorrected distance visual acuity (UDVA) improved from 0.58 to 0.31 logMAR (p < 0.001), with best corrected distance visual acuity (CDVA) improving from 0.03 to 0.02 logMAR (p = 0.7). On manifest refraction, the average spherical component decreased from −1.87 to −1.40 D (0.47 ± 2.12, p = 0.4). Cylinder decreased from 2.18 to 0.87 D (1.31 ± 1.14 D, p < 0.001). All HOAs decreased: total HO 0.94 to 0.58 (0.36 ± 0.42, p = 0.05); spherical aberration: 0.142 to −0.018 (0.160 ± 0.160, p < 0.001); secondary astigmatism: 0.21 to 0.11 (0.10 ± 0.11, p = 0.02); coma: 0.80 to 0.42 (0.38 ± 0.47, p = 0.03); trefoil: 0.33 to 0.29 (0.04 ± 0.17, p = 0.7). Conclusion: Utilizing HOA to guide the laser treatment in combination with CXL resulted in a significant decrease of HOA at 6 months postprocedure. This is a small case series, but demonstrates a promising trend of improved HOA. Considering that keratoconic eyes have very irregular surfaces with significant HOA, reducing these aberrations should improve best corrected quality of vision. Having longer follow-up and greater numbers may demonstrate a clearer improvement.

international journal of keratoconus and ectatic corneal diseases

Reduced High-order Aberrations using Wavefront-guided Partial Photorefractive Keratectomy and Accelerated Epithelium-off Corneal Cross-linking for Keratoconus