• Sadia Humayun, Aaiza Tahir, Mazhar Ishaq, Sabahat Arzoo, and Aizaz Ali Shah.
• Refractive Surgical Department, Armed Forces Institute of Ophthalmology, National University of Medical Sciences, Rawalpindi, Pakistan.
• J Coll Physicians Surg Pak. 2023 Nov 1; 33 (11): 126412701264-1270.

ObjectiveTo compare the visual and topographic outcomes between mechanical epithelial debridement followed by accelerated corneal collagen cross linking (CXL) vs. transepithelial phototherapeutic keratectomy followed by accelerated CXL for treatment of progressive keratoconus.Study DesignQuasi experimental study. Place and Duration of the Study: Armed Forces Institute of Ophthalmology (AFIO), National University of Medical Sciences, Rawalpindi, Pakistan, from December 2020 to December 2021.MethodologyOn the basis of surgical technique used, patients were divided into two groups, Group A comprising of twenty eyes that underwent mechanical epithelial removal followed by accelerated CXL, and Group B comprising of twenty-two eyes that underwent transepithelial phototherapeutic keratectomy (t-PTK) followed by accelerated CXL. All variables were recorded preoperatively and 6 and 12 months postoperatively and included uncorrected visual acuity (UCVA), corrected distance visual acuity (CDVA), MRSE (manifest refraction spherical equivalent), and keratometric indices (flat K, steep K, Kmax , mean K, thinnest pachymetry, KPI, K prob, CLMIaa, and I-S).ResultsForty-two eyes of twenty-nine patients were included in the study and were divided into two groups; Group A (mechanical epithelial removal followed by accelerated CXL) and Group B (t-PTK followed by accelerated CXL). The visual acuity improved in both the groups at 6 and 12 months, with more significant improvement in Group B in both UCVA (p=0.005) and CDVA (p=0.004) parameters. Keratometric outcomes showed significant differences in median values for flat K (p=0.048) and thinnest pachymetry (p=<0.001) in Group A, while significant difference in Kmax (p=0.024) and thinnest pachymetry (p=<0.001) in Group B. At 6 and 12 months, the CLMIaa, PPK, and I-S values were significantly lower in Group B (p=0.002 for all three indices).ConclusionTransepithelial PTK followed by accelerated CXL yielded better outcomes regarding visual acuity and keratomertic indices as compared to mechanical epithelial removal followed by accelerated CXL and did not show any significant decrease in corneal pachymetry.Key WordsMechanical, Corneal Collagen Crosslinking (CXL), Transepithelial, Phototherapeutic keratectomy, Keratoconus.

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