Sequential PRK and collagen cross-linking enhance results in keratoconus eyes

BERLIN — A combination of collagen cross-linking and partial PRK allows better and more stable results, according to one surgeon here.

After many years of experience, John Kanellopoulos, MD, said the two procedures can be performed sequentially.

"I do epithelial removal, partial PRK with [mitomycin C] and directly go on to cross-linking," he said at the European Society of Cataract and Refractive Surgeons meeting. In these cases, the aim of PRK is regularizing the cornea, rather than correcting refraction, Dr. Kanellopoulos said.

"It is more like a [phototherapeutic keratectomy] procedure," he said.

A more regular cornea will then allow a better distribution of forces by the cross-linking procedure.

A series of 325 patients was divided into two groups. In group A, corneal cross-linking was performed first and followed by PRK at a 6-month interval. In group B, the two procedures were performed sequentially and in the reverse order.

Statistically, group B did better in all of the fields evaluated, namely visual acuity, refraction, keratometry topography, endothelial integrity and corneal clarity. The sequential procedure is also easier and less stressful for the patient, Dr. Kanellopoulos said.