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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.

We present the pinhole iris-fixated diaphragm intraocular lens (IOL), which is a 1-piece black polycarbonate IOL with rigid iris-fixated haptics, an 8.5 mm overall length, a 6.0 mm diameter optic, and a central opening, the pinhole. The IOL was implanted in a 36-year-old man who had a history of debilitating dysphotopsia (star burst, halos, glare, and ghosting) and severe light sensitivity in his right eye following several interventions for keratoconus. The diameter of the central opening of the pinhole IOL, 2.0 mm, was based on the patient’s corneal aberration profile. Postoperatively, the dysphotopic symptoms and photophobia markedly improved. We recommend the use of the pinhole iris-fixated IOL in patients with severe photophobia or dysphotopsia refractory to other treatment modalities. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned. J Cataract Refract Surg 2015; 41:487–491 Q 2015 ASCRS and ESCRS

To report the visual, refractive, and clinical outcomes of simultaneous topography-guided partial photorefractive keratectomy (PRK) and corneal collagen crosslinking (CXL) in eyes with keratoconus.Private practice surgery center, Dubai, United Arab Emirates.Retrospective cohort study.Refraction, uncorrected (UDVA) and corrected (CDVA) distance visual acuities, flat and steep keratometry (K) readings, and complications were evaluated 1, 3, 6, and 12 months postoperatively.The study enrolled 31 eyes of 31 patients aged 21 to 42 years. All study parameters showed a statistically significant improvement at 3, 6, and 12 months over baseline values. At 12 months, the mean UDVA improved to 0.23 logMAR±0.33 (SD) from 0.79±0.36 logMAR (P.001) and the CDVA improved to 0.06±0.07 logMAR from 0.28±0.20 logMAR (P.001). The mean defocus decreased from 3.45±1.60 diopters (D) to 1.88±1.58 D (P.001). The flat K and steep K readings showed significant flattening. The mean refractive astigmatism decreased from -2.77±1.47 D to -0.98±0.76 D (P.001). The improvement in study parameters plateaued after 3 months.Simultaneous topography-guided partial PRK and CXL was effective, safe, and stable in keratoconus patients.No author has a financial or proprietary interest in any material or method mentioned.