Department of Ophthalmology and Visual Sciences, Paulista School of Medicine/Federal University of São Paulo (EPM/UNIFESP), São Paulo, Brazil.
Indian J Ophthalmol. 2023 Sep;71(9):3210-3218. doi: 10.4103/IJO.IJO_2557_22.
Compare the safety and efficacy of wavefront-guided photorefractive keratotomy (PRK) 6 months after cross-linking (CXL) to wavefront-guided PRK alone for refractive correction in patients with bilateral asymmetric corneal topography.
Prospective randomized clinical trial with 16 patients (32 eyes). CXL with subsequent PRK after 6 months in one eye, and PRK alone was performed in contralateral eyes. The follow-up was 10 years. We analyzed visual outcomes, Scheimpflug topography, and corneal haze evaluation.
Eyes in the PRK group showed better results than in the CXL + PRK group. Mean postoperative CDVA was 0.044 logmar (SD, 0.073) in the PRK group and 0.1 logmar (SD, 0.21) in the CXL + PRK group, the mean sphere was + 0.21 (SD, 0.6) D in the PRK group and 0.87 (SD, 2.3) D in the CXL + PRK group, and mean SE was -0.35 (SD, 0.65) D in the PRK group and 0.62 (SD, 2.32) D in the CXL + PRK group. In one patient, a steepening of 2.5 D and a thinning of 17 μm occurred in PRK alone group. Two patients in the CXL + PRK group presented corneal haze. The overall complication rate was 18,75% (haze and ectasia).
Non-simultaneous CXL and PRK procedures yielded good refractive results, but worse than those obtained with PRK alone. Although one patient in the PRK group developed corneal ectasia, the CXL + PRK group had a higher loss of vision lines, indicating less safety.
比较交联（CXL）后 6 个月行波前引导性光折射性角膜切削术（PRK）与单纯行波前引导性 PRK 治疗双侧角膜不对称性角膜地形图患者的安全性和疗效。
前瞻性随机临床试验，纳入 16 例（32 眼）患者。一只眼行 CXL 后 6 个月行 PRK，对侧眼行单纯 PRK。随访时间为 10 年。分析视力结果、Scheimpflug 地形图和角膜混浊评估。
PRK 组的眼部结果优于 CXL + PRK 组。PRK 组术后平均最佳矫正视力（CDVA）为 0.044 logMAR（标准差，0.073），CXL + PRK 组为 0.1 logMAR（标准差，0.21），PRK 组平均球镜为+0.21（标准差，0.6）D，CXL + PRK 组为 0.87（标准差，2.3）D，PRK 组平均等效球镜（SE）为-0.35（标准差，0.65）D，CXL + PRK 组为 0.62（标准差，2.32）D。在单纯 PRK 组中，有 1 例患者的屈光度增加了 2.5 D，角膜厚度减少了 17 μm。CXL + PRK 组中有 2 例患者出现角膜混浊。总的并发症发生率为 18.75%（混浊和扩张）。
非同期 CXL 和 PRK 手术可获得良好的屈光效果，但不如单纯 PRK 手术。尽管 PRK 组中有 1 例患者发生了角膜扩张，但 CXL + PRK 组视力丧失的风险更高，表明安全性较差。
