Purpose: The aim of the study is to compare the refractive results after simultaneous TransPRK and Cross-linking procedure for treatment of keratoconus with optimized and non-optimized customized ablation profiles; to introduce the concept of optimization in keratoconus and discuss its clinical significance; to find predictive factors for better refractive outcomes in simultaneous combined procedures and to propose therapeutic algorithm. Methods: Syrius schimpflug aberrometer (Schwind) was used to create non-optimized custom and optimized custom ablation profiles in keratoconic corneas. TransPRK ablation was performed with Schwind Amaris Eximer Laser (500 Hz). Cross-linking was done with Avedro cross-linking suit. Analysis of preoperative and postoperative refraction, visual acuity, keratometric and aberometric data was done for both groups. Correlative analysis of the preoperative and postoperative variables was done with Pierson statistical analysis. Results: 44 patients (70 eyes), age 19-67, 29 eyes with optimization, 41 eyes without optimization were followed for 18 months. A positive correlation was found between CCT and the amount of postoperative flattening in patients over 40 years of age. No correlation was found with Kavg. Conclusions: Long term results after simultaneous TransPRK + Cross linking show stability and safety. Optimization of refraction brings better refractive results compared to non-optimized procedure. It can be safely performed in thinner corneas and compensates for the hypermetropic shift generated by the cross-linking procedure.
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