SIMAR J. SINGH1, WILLIAM B. TRATTLER1,2, GABRIELA PEREZ2, DAVID T. LIN3

1Herbert Wertheim College of Medicine, Florida International University, Miami FL2Center for Excellence in Eye Care, Miami FL3University of British Columbia, Vancouver BC

Dr. Trattler has received funding for research, consulting and/or speaking from: CXLUSA

Purpose and MethodsPurpose: To report the results of bilateral CXL followed by

topography- guided PRK for a commercial airline pilot who required excellent uncorrected visual acuity to continue with his occupation.

Methods:A 33-year-old African American male commercial airline

pilot with advanced bilateral keratoconus & no previous ocular surgery was treated with epithelial-off CXL followed 4 months later by topography-guided PRK with the Allegretto laser platform. A comparison of UCVA, BCVA, pentacams, and placido-disk topographies were gathered pre & post CXL treatment and & post PRK.

ResultsOD Pre Op Pre PRK/ Post

CXLLast Visit/

Post CXL and PRK

UCVA 200 200 40

BCVA 50 40 30

Refraction -7.50+1.50x0

80

-8.00+0.75x105 -3.75+0.50x55

OS Pre Op Pre PRK/ Post CXL

Last Visit/Post CXL and

PRK

UCVA 400 50 25

BCVA 30 30 25

Refraction -5.75+1.50x1

00

-5.75+0.75x080 -2.50+0.75x120

Difference Map OD: Pre-Op to Post-CXL/ Pre-PRK

Post-CXLPre-Op

Difference Map

4 D Flatter

Difference Map OD: Pre-Op to Last Visit (Post-CXL and Post-PRK)

Difference Map

Pre-Op Post-CXL/ Post-PRK

11 D Flatter

ConclusionsThis case illustrates the potential for marked

improvement in UCVA and BCVA in patients who have undergone CXL followed by topography-guided PRK. Patients with advanced keratoconus may experience greater improvement in visual acuity and experience a greater improvement in quality of vision with CXL followed by PRK when compared to CXL alone.

KEYWORDS: Keratoconus, Corneal Crosslinking, Photorefractive keratectomy (PRK).