Corneal endothelial damage after simultaneous PRK and corneal cross-linking in stable keratoconus

Purpose: To describe a case of endothelial damage after photorefractive keratectomy (PRK) combined with corneal cross-linking (CXL). Observations: A 34-year-old man with diagnosis of stable keratoconus presented at our clinic complaining of vision loss in the left eye after same-day simultaneous PRK and CXL. One year postoperatively, slit-lamp examination showed central corneal haze and specular microscopy demonstrated reduced endothelial cell density compared with the preoperative state. Corrected distance visual acuity decreased from 18/20 preoperatively to 20/60 postoperatively. The thinnest corneal thickness value decreased from 432 μm preoperatively to 328 μm postoperatively. Conclusions and Importance: The present case demonstrates the importance of appropriate determination of treatment parameters for simultaneous PRK and CXL in keratoconus, even if the disease is stable prior to treatment. Keywords: Keratoconus, Corneal cross-linking, PR