Combined photorefractive keratectomy and cross-linking. Pushing the limits

Correction of refractive error through laser-assisted means has soared in popularity in recent years, allowing it to become an increasingly routine surgical procedure. Technique refinement and adjustments resulted in laser-assisted refractive surgery to be combined with treatments such as collagen cross linking (CXL). This has broadened safety parameters and widened the treatment boundaries. Laser correction combined with CXL has been advocated in the treatment of high refractive errors as a safe option for full refractive correction while increasing corneal biomechanical stability. We present a complicated case where a young female patient with a preoperative best-corrected visual acuity (BCVA) of 20/20 in each eye was fully corrected by excimer laser followed by CXL. Factors potentially leading to inflammation, such as ocular surface disease, in addition to laser treatment and CXL, resulted in persistent epithelial defect followed by corneal melt and subsequent thinning. After the treatment, the patient relies on rigid gas-permeable contact lenses, achieving a BCVA of 20/25 and 20/23 in the right eye and left eye, respectively.