AIM: To evaluate the visual, refractive and clinical outcomes of non-topography-guided photorefractive keratectomy(PRK)and corneal collagen cross linking(CXL)in eyes with keratoconus.

METHODS: Totally 34 cases were evaluated for uncorrected distance visual acuities(UDVA)and corrected distance visual acuities(CDVA), flat and steep keratometry readings, and complications were evaluated at 1mo, 3mo, 6mo and 12mo postoperatively.

RESULTS: Thirty-four patients with mean age of 23.3±4.0 years. Statistically significant improvement was shown in UCVA and CDVA, with steadiness of refection for 1y postoperative. T-test showed a significant difference(P<0.05)in all means between the preoperative and postoperative values(visual acuity, spherical and cylinder changes), with stability over a 1y follow up. Fourier analysis of postoperative images showed an axis shift perpendicular to the preoperative axis.

CONCLUSION: Simultaneous non-topography-guided PRK and CXL is safe and effective surgical alternative for keratoconus, yielding improvement in the UDVA, CDVA, and refractive status. Stabilization was achieved as early as 3mo after surgery, the only advantage of topography-guided over non-topography-guided PRK might be the minimal over correction of sphere and the cylindrical axis shift in some patients as detected by Fourier analysis of postoperative pentacam.