Corneal endothelial damage after simultaneous PRK and corneal cross-linking in stable keratoconus

To describe a case of endothelial damage after photorefractive keratectomy (PRK) combined with corneal cross-linking (CXL).

A 34-year-old man with diagnosis of stable keratoconus presented at our clinic complaining of vision loss in the left eye after same-day simultaneous PRK and CXL. One year postoperatively, slit-lamp examination showed central corneal haze and specular microscopy demonstrated reduced endothelial cell density compared with the preoperative state. Corrected distance visual acuity decreased from 18/20 preoperatively to 20/60 postoperatively. The thinnest corneal thickness value decreased from 432 μm preoperatively to 328 μm postoperatively.

The present case demonstrates the importance of appropriate determination of treatment parameters for simultaneous PRK and CXL in keratoconus, even if the disease is stable prior to treatment.