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PRK combined with cross-linking may outperform cross-linking alone for treatment of keratoconus
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Topography-guided PRK followed by corneal collagen cross-linking yielded a significantly greater improvement in vision than cross-linking alone in eyes with progressive keratoconus, a study found.
Both procedures yielded similarly stable postoperative outcomes.
The prospective study included 60 eyes of 48 patients. Thirty eyes underwent combined topography-guided PRK followed by cross-linking, and 30 eyes underwent cross-linking alone. Mean follow-up was 39 months.
Depth of cross-linking treatment was 269.8 µm in the cross-linking only group and 299.7 µm in the combined group; the difference was statistically significant (P < .001).
At final follow-up, mean logMAR uncorrected distance visual acuity improved by 9.1 letters in the cross-linking only group and 26.9 letters in the combined group. The between-group difference was statistically significant (P = .004).
Mean logMAR corrected distance visual acuity improved by 4.7 letters in the cross-linking only group and 8.6 letters in the combined group. The between-group difference was significant (P = .034).
Sixty-three percent of patients in the combined treatment group and 27% in the cross-linking only group gained two or more lines of corrected distance visual acuity; the difference was statistically significant (P = .009).
The difference between preoperative and postoperative spherical equivalent refraction and defocus equivalent refraction was significant in the combined treatment group (both P < .0001) but not in the cross-linking only group.
Also at final follow-up, steep and flat keratometry readings were significantly flatter in the combined treatment group than in the cross-linking only group.
Endothelial cell density was similar in both groups. – by Matt Hasson
Disclosure: The authors report no relevant financial disclosures.
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Kontadakis GA, et al. Ophthalmology. 2016;doi:10.1016/j.ophtha.2016.01.010.
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