Efficacy of Photorefractive Keratectomy vs. Topography-Guided Photorefractive Keratectomy for Refractive Errors and Aberrations Post-Penetrating Keratoplasty
Authors: Kijonka Magdalena , Nowińska Anna , Wylęgała Adam , Orzechowska-Wylęgała Bogusława , Dugiełło Bogdan , Kryszan Katarzyna , Wylęgała Edward 
Published: February 2025

Background: Managing post-keratoplasty astigmatism remains challenging. Even though graft viability is the main concern in keratoplasty, astigmatism might hinder vision recovery following a successful corneal transplant. Photorefractive keratectomy (PRK) and topography-guided PRK may be options for correcting refractive errors in patients who underwent keratoplasty. The aim of the study was to compare the results of PRK and topography-guided PRK in patients who had undergone corneal keratoplasty. Methods: This study was conducted at the Chair and Ophthalmology Clinic of the Medical University of Silesia, at the Railway Hospital Katowice, from 2023 to 2024. Patients who underwent penetrating keratoplasty due to keratoconus or corneal scar (post-traumatic and post-inflammatory) with a residual spherical myopic or mixed myopic astigmatic refractive defect were included in this study. The studied patients were divided into two groups: 15 patients underwent PRK and 15 patients underwent topography-guided PRK. Each participant underwent a preoperative examination, including uncorrected visual acuity (UCVA) and best spectacle-corrected visual acuity (BSCVA) measured on the Snellen chart (LCD panel for visual acuity testing Frey CP-400, Optotech Medical, Niepołomnice, Niepołomice, Poland), cycloplegic refraction, corneal pachymetry and topography (Schwind Sirius+, Pentacam), wavefront aberrations (Schwind Peramis, Pentacam), applanation tonometry, and anterior and posterior segment examinations, conducted at baseline and 1, 3, 6, and 12 months. Results: Keratoconus was the most common reason for keratoplasty (80% vs. 60%). Following PRK, the mean KI in group (1) decreased significantly to 43.88 ± 3.64 (p < 0.001), and in the group (2), the mean diopters decreased significantly after the intervention to 46.46 ± 2.80 (p < 0.001). The mean spherical refractive error in group (2) changed significantly after the intervention, reaching −2.72 ± 1.28 D (p < 0.001). The mean cylinder in group (1) changed significantly after PRK to have a mean of −2.75 ± 1.44 D (p < 0.001). Also, in group (2), it changed significantly after the intervention to have a mean of −2.95 ± 1.99 D (p < 0.001). There was a significant increase in both uncorrected visual acuity (UCVA) and best-corrected visual acuity (BCVA) after topography-guided PRK at all the follow-up points of 1, 3, 6, and 12 months (p < 0.001). The mean higher-order corneal aberrations (HOAs) after topography-guided PRK were 1.33 ± 0.50, ranging from 0.22 to 2.34 (p < 0.001). Conclusions: Topography-guided PRK is safer and more effective in correcting aberrations and refractive errors after corneal keratoplasty than regular PRK. Additionally, topography-guided PRK reduces high-order aberrations by utilizing advanced topographic mapping of the cornea, enabling precise customization of the treatment to address individual corneal surface irregularities.