Topography/wavefront-guided photorefractive keratectomy combined with crosslinking for the treatment of keratoconus: preliminary results

To evaluate the clinical outcomes of topography/wavefront-guided (TWFG) photorefractive keratectomy (PRK) using a new high-definition aberrometer combined with epithelium-off crosslinking (CXL-Plus). Design: Prospective case series study. Methods: Patients with grade I or II keratoconus, according to the Amsler-Krumeich classification, were included in this prospective case series. All cases underwent TWFG PRK using the VISX STAR S4 IR excimer laser and the new iDesign 2.0 system, followed by accelerated epithelium-off CXL. Visual, refractive, ocular aberrometric, and safety outcomes were evaluated during a 6-month follow-up. Results: Thirty-five eyes of 19 patients were included. A significant improvement was observed in the uncorrected and corrected distance visual acuities (P < .001). Manifest sphere and cylinder were reduced significantly (P <= .001), with a total of 20 eyes (57%) and 30 eyes (86%) having a postoperative spherical equivalent within +/-0.50 and +/-1.00 diopter, respectively. Most corneal irregularity indexes and the level of ocular higher-order aberrations, primary coma, and trefoil (P < .05) were significantly reduced postoperatively. No significant corneal haze or safety issues were observed. Conclusions: TWFG PRK, using the iD2 system with simultaneous CXL, regularized the cornea by correcting the spherocylindrical error and minimizing the amount of higher-order aberrations in mild-to-moderate keratoconus.