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Comparative analysis of safety and efficacy of photorefractive keratectomy versus photorefractive keratectomy combined with crosslinking

Authors Sachdev GS, Ramamurthy S, Dandapani R

Received 9 November 2017

Accepted for publication 16 January 2018

Published 30 April 2018 Volume 2018:12 Pages 783—790

DOI https://doi.org/10.2147/OPTH.S156500

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Amy Norman

Peer reviewer comments 2

Editor who approved publication: Dr Scott Fraser


Gitansha Shreyas Sachdev, Shreyas Ramamurthy, Ramamurthy Dandapani

Refractive Services, The Eye Foundation, Coimbatore, India

Purpose: To assess the safety, efficacy, and refractive predictability of half-fluence accelerated corneal collagen crosslinking (CXL) applied concurrently with photorefractive keratectomy (PRK), and compare the results to standard PRK.
Setting: Refractive Services, The Eye Foundation, Coimbatore, India.
Design: Interventional comparative case series.
Methods: Patients seeking refractive correction for myopia or myopic astigmatism were included in the study. Photorefractive keratectomy with concurrent half-fluence crosslinking (PRK Xtra) was performed in eyes with borderline suspicious tomography (not amounting to forme fruste keratoconus) or low pachymetry between 450 and 474 µm with an otherwise unremarkable corneal tomography. Eyes with normal corneal tomography and thickness between 475 and 500 µm underwent standard PRK. The minimum follow-up period was 1 year.
Results: In total, 109 eyes underwent PRK Xtra (Group A) and 118 eyes underwent PRK alone (Group B). The preoperative MRSE was −3.64 D and −3.38 D in Groups A and B, respectively (P=0.28). Group A had a significantly higher number of eyes with thinner corneas (P<0.01) and corneal tomographic abnormalities (P=0.02). At 1 year follow-up, 96.3% of eyes in group A as against 99.1% of eyes in group B achieved a best corrected distance visual acuity (CDVA) of 20/20 or better. No iatrogenic ectasia or hyperopic shift secondary to progressive flattening was noted in the PRK Xtra group. No significant difference in incidence of haze was noted.
Conclusion: PRK Xtra showed comparable safety, efficacy, and stability to PRK in eyes with thinner pachymetry and tomographic abnormalities. Combining crosslinking with PRK in suspicious tomographies augurs for safe and predictable outcomes.

Keywords: photorefractive keratectomy, PRK, corneal collagen crosslinking, CXL, PRK Xtra

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