Comparison of safety and efficiency of corneal topography-guided photorefractive keratectomy and combined with crosslinking in myopic correction

Abstract

To compare the safety and efficiency of simple corneal topography-guided (T-CAT) photorefractive keratectomy (PRK) and T-CAT PRK combined with crosslinking (CXL) to correct myopia with borderline suspicious tomography. Eyes with suspicious tomography (not classified as forme fruste keratoconus) underwent PRK combined with CXL. The suspicious tomography showed irregular posterior corneal morphology or maximum elevation value of the central 6 mm zone of the posterior surface (MEL) >15 μm, or Belin/Ambrósio Enhanced Ectasia Index (BAD-D) was >1.6. The PRK group was generated and matched within 2 μm for MEL, 0.3 for BAD-D value, and 0.5 D for manifest refractive spherical equivalent (MRSE) compared with the PRK-CXL group. PRK-CXL exhibited a larger MRSE (0.09 ± 0.22 D vs −0.03 ± 0.24 D, P = .02) and a larger sphere (0.14 ± 0.22 D vs 0.01 ± 0.21 D, P = .002) compared with PRK alone at 18 months postoperatively. The magnitude change and relative change rate of stiffness parameter A1 in the PRK-CXL were smaller than in the PRK group (−15.72 ± 14.56 vs −19.95 ± 14.37, P = .04, for magnitude change and −0.16 ± 0.15 vs −0.20 ± 0.14, P = .02, for relative change rate). In the PRK-CXL and PRK groups, 4.8% and 6.9% of eyes suffered grade 0.5 haze at postoperative 18-month. No cases of ectasia were reported in either group. PRK in combination with prophylactic crosslinking showed comparable safety and efficacy, but higher biomechanical stability compared to PRK alone, thus, the additional CXL plays a measurable role in reducing the change in corneal biomechanical properties after PRK in suspicious eyes.

Comparison of refractive surgeries (SMILE, LASIK, and PRK) with and without corneal crosslinking: systematic review and meta-analysis

“…38 By contrast, Li et al, who did not apply mitomycin in any of the groups, identified 4.8% of eyes with grade 0.5 haze in the PRK Xtra group and 6.4% in the PRK-only group ( P = .22). 37 It is important to mention that studies not covered in this section did not report any instances of corneal complications, including haze. Moreover, there were no documented occurrences of corneal ectasia across all patients within the follow-up period.…”

Changes in Corneal Morphology and Biomechanics in Cases of Small Incision Lenticule Extraction with Prophylactic Accelerated Collagen Cross-Linking

“…Numerous studies have con rmed CXL's role in halting the progression and promoting corneal stabilization of keratoconus and other forms of ectasia [6,8,9]. In recent years, a simultaneous combination of prophylactic CXL and corneal refractive surgeries (PRK Xtra, LASIK Xtra, and SMILE Xtra) has emerged and shown good visual and refractive results [10][11][12]. ese surgeries aim to improve the cornea's postoperative biomechanical stability and potentially prevent future ectasia in cases where the topographic indices or the clinical history is suggestive of "at risk" corneas.…”