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Purpose To study the evolution of visual and refractive outcomes through the first year after simultaneous topography-guided photorefractive keratectomy (t-PRK) and corneal collagen cross-linking (CXL) in keratoconus. Methods This retrospective case series included 85 eyes of 66 patients with a mean age of 26.3 ± 5.7 years, which underwent simultaneous t-PRK with accelerated CXL. Patients were examined for uncorrected distance visual acuity and corrected distance visual acuity (CDVA), flat and steep keratometry readings, and manifest refraction spherical equivalent at 1, 3, 6, and 12 months. Results At 12 months, all study parameters demonstrated a statistically significant improvement with uncorrected distance visual acuity 0.46 ± 0.49 logMAR (vs. 0.86 ± 0.39 logMAR preoperatively), CDVA 0.11 ± 0.12 logMAR (vs. 0.41 ± 0.27 logMAR preoperatively), manifest refraction spherical equivalent -2.80 ± 4.47 D (vs. -4.51 ± 4.68 D preoperatively), flat keratometry 43.84 ± 3.24 D (vs. 44.61 ± 3.12 D preoperatively), and steep keratometry 46.05 ± 3.94 D (vs. 48.10 ± 3.68 D preoperatively). Although 90.6% eyes gained 1 or more lines of CDVA, no eyes lost any lines of CDVA. In all, 37.6% of the eyes demonstrated an improvement of 4 or more lines of CDVA with a maximum improvement of 11 lines of CDVA in 1 eye. Conclusions Simultaneous t-PRK with accelerated CXL improved the spherocylindrical refraction and visual function of keratoconus eyes, and the outcomes were stable through 12 months' follow-up. Future studies with longer follow-up and larger data set are necessary to validate the results of the current study and evaluate the long-term safety and efficacy.

Corneal cross linking (CXL) has significant supporting evidence suggesting that it stabilizes keratoconus (KC) and increases corneal rigidity. Randomized clinical trials demonstrating this in a statistically significant manner would still be welcomed however.