title: Simultaneous topography-guided photorefractive keratectomy followed by corneal collagen cross-linking for keratoconus.
abstract: OBJECTIVE
  To present the long-term results after simultaneous photorefractive keratectomy followed by corneal collagen cross-linking for keratoconus.
  
  
  METHODS
  Prospective, interventional, consecutive case series.
  
  
  METHODS
  In this study, 26 patients (31 eyes) with progressive keratoconus were included. All patients underwent customized topography-guided photorefractive keratectomy immediately followed by corneal collagen cross-linking with the use of riboflavin and ultraviolet A irradiation. Epithelium was removed by transepithelial phototherapeutic keratectomy in all cases.
  
  
  RESULTS
  Mean follow-up was 19.53 ± 3.97 months (range, 12 to 25 months). Mean preoperative spherical equivalent was -2.3 ± 2.8 diopters (D), whereas at the last follow-up examination, it was significantly (P < .001) reduced to -1.08 ± 2.41 D. Logarithm of the minimal angle of resolution uncorrected and best-corrected visual acuity were reduced significantly by 0.46 and 0.084 (P < .001), respectively, at the last follow-up examination. Finally, mean steep and flat keratometry readings were reduced by 2.35 (P < .001) and 1.18 (P = .013) at the last follow-up examination.
  
  
  CONCLUSIONS
  Simultaneous photorefractive keratectomy followed by corneal collagen cross-linking seems to be a promising treatment alternative in our series of keratoconic patients.
authors.affiliation: Institute of Vision and Optics University of Crete, Medical School, Heraklion, Crete, Greece. kymionis@med.uoc.gr
authors.forename: George D
authors.initials: GD
authors.lastname: Kymionis
authors.forename: Dimitra M
authors.initials: DM
authors.lastname: Portaliou
authors.forename: George A
authors.initials: GA
authors.lastname: Kounis
authors.forename: Aliki N
authors.initials: AN
authors.lastname: Limnopoulou
authors.forename: Georgios A
authors.initials: GA
authors.lastname: Kontadakis
authors.forename: Michael A
authors.initials: MA
authors.lastname: Grentzelos
mesh_terms: D000328:Adult; D003094:Collagen / Q000378:metabolism*; D003131:Combined Modality Therapy; D003319:Corneal Stroma / Q000378:metabolism*; D019781:Corneal Topography; D003432:Cross-Linking Reagents; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007640:Keratoconus / Q000188:drug therapy / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D054018:Lasers, Excimer / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010778:Photochemotherapy; D018903:Photorefractive Keratectomy; D017319:Photosensitizing Agents / Q000627:therapeutic use; D011446:Prospective Studies; D012029:Refraction, Ocular / Q000502:physiology; D012256:Riboflavin / Q000627:therapeutic use; D016896:Treatment Outcome; D014466:Ultraviolet Rays; D014792:Visual Acuity / Q000502:physiology; D055815:Young Adult
chemical_list: D003432:Cross-Linking Reagents; D017319:Photosensitizing Agents; D003094:Collagen; D012256:Riboflavin