{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T21:58:13Z","timestamp":1789077493849,"version":"build-2803163510"},"reference-count":53,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,8,12]],"date-time":"2024-08-12T00:00:00Z","timestamp":1723420800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec><jats:title>Purpose<\/jats:title><jats:p>To comprehensively compare the long-term outcome of the combined topography guided photorefractive keratectomy (TG-PRK) with accelerated corneal cross-linking (ACXL) and ACXL alone in eyes with progressive keratoconus. The analysis focused on the changes in the detailed corneal aberrometric values.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This single-center, prospective cohort study included 28 patients (30 eyes) of the TG-PRK plus ACXL group and 14 patients (15 eyes) of the ACXL alone group. The mean duration of the follow-up was 44\u2009\u00b1\u200910.18\u2009months (ranged from 31 to 65\u2009months). The preoperative data and the postoperative measurement data at the last follow-up visit, including demographic data, uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), manifest refraction, corneal topography, pachymetry, aberrometry and densitometry were analyzed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The CDVA significantly improved in the TG-PRK plus ACXL group at the last follow-up visit (<jats:italic>p<\/jats:italic>\u2009=\u20090.006), while no significant improvement was found in the ACXL alone group (<jats:italic>p<\/jats:italic>\u2009=\u20090.432). The maximal keratometry of the anterior corneal surface (Kmax) of both groups significantly decreased at the last follow-up visit (<jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.05). Compared with the ACXL alone group, the Kmax of the TG-PRK plus ACXL group showed a greater decline (<jats:italic>p<\/jats:italic>\u2009=\u20090.008). The total corneal aberrations, the corneal lower-order aberrations (LOAs), the corneal higher order aberrations (HOAs), the vertical coma and the spherical aberration (SA) at the 4.0\u2009mm and 6.0\u2009mm zone of the TG-PRK plus ACXL group significantly decreased at the last follow-up visit (all <jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.05). The declines of the total corneal aberrations, the corneal LOAs, the corneal HOAs and the vertical coma at the 4.0\u2009mm and 6.0\u2009mm zone of the TG-PRK plus ACXL group were significantly higher than those in the ACXL alone group (<jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Compared with ACXL alone, combined TG-PRK with ACXL procedure had a significantly higher reduction in the corneal HOAs and better CDVA, while providing a similar long-term stability and safety. For progressive keratoconus patients with adequate corneal thickness, the combined procedure might be a recommended treatment option.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fmed.2024.1420264","type":"journal-article","created":{"date-parts":[[2024,8,12]],"date-time":"2024-08-12T05:03:32Z","timestamp":1723439012000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":6,"title":["Topography-guided photorefractive keratectomy combined with accelerated corneal collagen cross-linking versus cross-linking alone for progressive keratoconus: a long-term prospective cohort study"],"prefix":"10.3389","volume":"11","author":[{"given":"Zhihao","family":"Dai","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ziyuan","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yufei","family":"Yuan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuexin","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuo","family":"Yu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yueguo","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2024,8,12]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"2705","DOI":"10.2147\/OPTH.S392665","article-title":"Keratoconus diagnosis and treatment: recent advances and future directions","volume":"17","author":"Bui","year":"2023","journal-title":"Clin Ophthalmol"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"e22","DOI":"10.1097\/ICO.0000000000000499","article-title":"Inflammation in keratoconus","volume":"34","author":"Galvis","year":"2015","journal-title":"Cornea"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"1725","DOI":"10.4103\/ijo.IJO_3011_20","article-title":"Systemic immune-inflammation index, neutrophil-to-lymphocyte ratio, and platelet-to-lymphocyte ratio levels are associated with keratoconus","volume":"69","author":"Elbeyli","year":"2021","journal-title":"Indian J Ophthalmol"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"246","DOI":"10.1080\/09273948.2020.1780271","article-title":"Is keratoconus an inflammatory disease? 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