Corneal Cross-Linking Combined With Lasik, Lasek, Prk, Ptk, and Smile Refractive Surgeries Publisher



Mohammadpour M¹ ; Khorraminejad M² ; Shakor YA³ Show Affiliations
Source: Keratoconus: Optical and Surgical Management Published:2024

Abstract

Corneal cross-linking (CXL) using riboflavin and ultraviolet A irradiation has emerged as an established treatment for halting the progression of corneal ectatic disorders like keratoconus. More recently, CXL has been combined with refractive surgeries such as photorefractive keratectomy (PRK), laser-assisted in-situ keratomileusis (LASIK), and small incision lenticule extraction (SMILE) for simultaneously treating refractive errors and stabilizing the cornea in keratoconus and post-refractive ectasia. This chapter reviews recent studies evaluating the visual, refractive, and keratometric outcomes of combining CXL with PRK, LASIK, LASEK, and SMILE procedures in various sequences. Most studies reported significant improvements in uncorrected and corrected distance visual acuity, reduction in spherical equivalent refraction, cylinder, keratometry readings, and higher-order aberrations when CXL was combined with refractive surgery compared to refractive surgery alone. The combined approach offered better corneal stability and prevented progression of ectasia. Sequential CXL followed by PRK/LASIK after 6–12 months showed better outcomes than simultaneous combined procedures in some studies. Accelerated CXL protocols, topography-guided ablation, and customized treatments provided superior results. No major complications were noted. In summary, corneal CXL combined with refractive surgery appears a safe and effective approach for visual rehabilitation in keratoconus and ectasia with good long-term stability. © 2025 selection and editorial matter, Mehrdad Mohammadpour and Masoud Khorrami-Nejad; individual chapters, the contributors.