Laser vision correction (LASIK, PRK, SMILE) with simultaneous accelerated corneal crosslinking

Laser in-situ keratomileusis (LASIK Xtra), photorefractive keratectomy (PRK Xtra) and small-incision lenticule extraction (SMILE Xtra) are procedures currently performed worldwide. This review analyses recent literature (2020-2025) on corneal refractive surgery combined with simultaneous corneal crosslinking (CXL) (LASIK Xtra, PRK Xtra and SMILE Xtra) to determine its overall safety and efficacy.

A comprehensive literature search of various electronic databases (PubMed, PubMed Central and MEDLINE) was performed up to 30 December 2025 and articles in English pertaining to clinical outcomes of LASIK Xtra, PRK Xtra and SMILE Xtra published between 2020 to 2025 were included. Overall results including efficacy and safety were evaluated. Efficacy and safety indices are calculated where possible.

Ten relevant studies were found for LASIK Xtra, 3 for PRK Xtra and 8 for SMILE Xtra. Current studies show that refractive surgery and simultaneous CXL produces comparable results in terms of refractive and keratometric stability to refractive surgery alone. Studies that performed LASIK Xtra, PRK Xtra and SMILE Xtra procedures in susceptible eyes showed no cases of postoperative keratectasia. Studies evaluating corneal biomechanical properties showed that LASIK Xtra, PRK Xtra and SMILE Xtra conferred some biomechanical advantages.

Simultaneous accelerated cross-linking and laser vision correction is both safe and effective for the treatment of myopia. No cases of postoperative keratectasia was reported in studies where these procedures were performed in susceptible eyes, indicating a certain biomechanical advantage conferred.