Related Experiment Video
Updated: Feb 9, 2026
Three Different Protocols of Corneal Collagen Crosslinking in Keratoconus: Conventional, Accelerated and Iontophoresis
Published on: November 12, 2015
Combined wavefront-guided transepithelial photorefractive keratectomy and corneal crosslinking for visual
Daniel M Gore1, Marcello T Leucci1, Vijay Anand1
1From the External Disease Service (Gore, Leucci, Anand, Fernandez-Vega Cueto, Allan), and the Optometry Department (Leucci, Anand), Moorfields Eye Hospital, London, United Kingdom; Schwind eye-tech-solutions GmbH & Co. KG (Arba Mosquera), Kleinostheim, Germany.
Purpose:
To present 24-month results from the transepithelial photorefractive keratectomy (PRK)-corneal crosslinking (CXL) trial using simultaneous accelerated CXL and a new tissue-saving ocular wavefront-guided transepithelial PRK algorithm aiming to reverse visual loss in early-stage keratoconus without compromise to stabilization of disease progression.
Setting:
Moorfields Eye Hospital, London, United Kingdom.
Design:
Prospective case series.
Method:
Patients with progressive grades I to III keratoconus and logarithm of the minimum angle of resolution (logMAR) corrected distance vision acuity (CDVA) worse than 0.00 (20/20) were included. Consecutive matched historical controls treated only with accelerated CXL were the control group. The main outcome measure was change in logMAR CDVA.
Results:
The study group comprised 47 eyes of 47 patients (mean age 24.6 years ± 3.8 [SD]). The CDVA improved from 0.28 ± 0.21 logMAR (20/60) preoperatively to 0.15 ± 0.14 logMAR (20/30) 24 months after transepithelial PRK-CXL (P < .001). Twelve eyes gained and 1 eye lost 2 lines or more of CDVA. The mean stromal ablation depth at the cone apex was 35 ± 15 μm. Significant reductions in the maximum keratometry (K) reading and coma were evident in topographic comparison maps. The controls (n = 47) had no significant changes in CDVA, higher-order aberrations, or K values. The mean K values in both groups were stable from 6 months after treatment.
Conclusion:
Ocular wavefront-guided transepithelial PRK-CXL resulted in significant gains in CDVA without compromising CXL efficacy over a 24-month follow-up.
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