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Abstract Conventional approaches to treating mild to moderate keratoconus involve eyeglasses and rigid gas permeable contact lenses. Nonetheless, some patients are unable to tolerate contact lens and spectacle correction is insufficient in some cases. A combination of corneal collagen cross-linking with photorefractive keratectomy, a standard laser-assisted refractive surgery is expected to have greater efficacy in the management of keratoconus. The main purpose of the combined treatment of keratoconus with photorefractive keratectomy / corneal collagen cross-linking involves strengthening the cornea and halting the disease progression by corneal collagen cross-linking and to improve the quality of vision via photorefractive keratectomy. The main objective of this study was to evaluate the effectiveness of combined corneal collagen cross-linking and topography-guided photorefractive keratectomy in cases of mild and moderate keratoconus. This was a clinical trial study was conducted, including20 patients with grade 1 or 2 stable keratoconus. The duration of the study ranges from 6 to 12 months. The study included 20 eyes of 10 patients with grade 1 or 2 stable keratoconus 12 eyes belonged to males (60%) and 8 eyes belonged to females (40%). The age of patients ranged from 20 to 38 years with a mean of 29.7 ± 6.25.A written informed consent was obtained from all patients. Patients` eyes were examined preoperatively and post operatively twice (after one month and six months). The main results of the study revealed that: There was a statistically significant difference between the mean preoperative log MAR UDVA (0.87 ± 0.19) and 1-month postoperative log MAR UDVA (0.49±0.17) (𝑃 < 0.001). UDVA continued to improve progressively until the end of the 6-month follow-up period (0.30 ± 0.15) that was statistically significant (𝑃 < 0.001). There was not statistically significant difference between the mean preoperative log MAR CDVA (0.31 ± 0.13) and 1-month postoperative log MAR CDVA (0.30 ±0.15) (𝑃 > 0.05). UDVA continued to improve progressively until the end of the 6-month follow-up period (0.30 ± 0.15). The means of maximum and minimum keratometry preoperatively were (49.6±4.79) and (45.7±3.2) respectively and one month postoperatively they improved to (46.5±3.6) and (44.05±3.7) respectively with statistically significant difference (p<0.001) and continued significant improvement till 6-month follow-up period to (46.4±3.8) and (43.5±3.6) respectively (p<0.001) The median of cylindrical error was 2.25 diopter preoperatively and 1- and 6- month postoperatively was 1.25 and 1.125 diopter respectively with statistically significant improvement (p<0.05) In summary, combining corneal collagen cross-linking to refractive surgeries such as topography-guided photorefractive keratectomy is found to be a safe and effective method in providing corneal stability as well as significantly improving functional visual acuity with few minor complications. This combined technique also prevents regression of keratoconus and reduce the risk of keratectasia. Corneal collagen crosslinking combined with photorefractive keratectomy is a promising therapeutic approach in ophthalmology that can be successfully used to treat progressive keratoconus and other corneal ectatic disorders and to enhance visual acuity. |