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Purpose: To assess anterior corneal higher-order aberrations (HOAs) after corneal crosslinking (CXL) and intrastromal corneal ring segments (Intacs) used adjunctively. Setting: Cornea and refractive surgery practice. Design: Prospective, randomized clinical trial. Methods: One hundred fifty-eight eyes of 150 patients were randomized into 2 groups: concurrent, Intacs and CXL during the same session (n = 81), or sequential, Intacs followed by CXL 3 months later (n = 77). Outcomes included changes in total, coma, trefoil, and spherical anterior corneal HOA 6 months after Intacs/CXL. The change in anterior corneal HOAs was correlated with the change in uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), and topography indices of maximum keratometry (Kmax), maximum flattening keratometry (Kmaxflat), and inferior-superior (I-S) ratio. A subjective visual function questionnaire was also analyzed. Results: UDVA, CDVA, Kmax, I-S, and Kmaxflat all improved 6 months after treatment (UDVA = -0.22 +/- 0.34, P <.001; CDVA = -0.13 +/- 0.24, P <.001; Kmax = -3.1 +/- 3.0D, P <.001; I-S = -4.2 +/- 5.0 diopters [D], P <.001; Kmaxflat = -7.9 +/- 4.0 D, P <.001). Total anterior corneal HOA, vertical coma, and horizontal coma anterior corneal HOAs significantly improved by -1.05 +/- 0.93 [mu]m (P <.001), -1.53 +/- 1.18 [mu]m (P <.001), and -0.35 +/- 0.57 [mu]m (P <.001), respectively. Spherical anterior corneal HOAs increased by 0.24 +/- 0.70 [mu]m (P <.001) at 6 months after Intacs/CXL. The change in trefoil was not statistically significant (P trefoil0 =.06, P trefoil30 =.2). There were no significant differences between the changes in anterior corneal HOAs in the sequential and same-day Intacs/CXL groups. The change in total anterior corneal HOAs was correlated with Kmax, Kmaxflat, and the I-S ratio. There was no correlation between the change in anterior corneal HOAs and the change in visual acuity or visual function survey responses. Conclusions: Total, horizontal coma, and vertical coma anterior corneal HOAs improved after Intacs/CXL. Spherical anterior corneal HOAs increased postoperatively, and there was no change in trefoil. Improvement of anterior corneal HOAs did not correlate with visual acuity improvement or subjective visual satisfaction outcomes. [ABSTRACT FROM AUTHOR]

Purpose: To determine changes in higher-order aberrations (HOAs) after corneal collagen crosslinking (CXL). Setting: Cornea and refractive surgery practice. Design: Prospective randomized controlled clinical trial. Methods: Corneal and ocular HOAs were measured and analyzed using the Pentacam device and Ladarwave aberrometer, respectively, at baseline and 12 months after CXL. Results: Ninety-six eyes (64 keratoconus, 32 ectasia) of 73 patients had CXL. A fellow-eye control group comprised 42 eyes. The mean preoperative total anterior corneal HOAs, total coma, 3rd-order coma, and vertical coma were 4.68 μm ± 2.33 (SD), 4.40 ± 2.32 μm, 4.36 ± 2.30 μm, and 4.04 ± 2.27 μm, respectively. At 1 year, the mean values decreased significantly to 4.27 ± 2.25 μm, 4.01 ± 2.29 μm, 3.96 ± 2.27 μm, and 3.66 ± 2.22 μm, respectively (all P<.001). There were no significant changes in posterior corneal HOAs. The mean preoperative total ocular HOAs, total coma, 3rd-order coma, trefoil, and spherical aberration were 2.80 ± 1.0 μm, 2.60 ± 1.03 μm, 2.57 ± 1.03 μm, 0.98 ± 0.46 μm, and 0.90 ± 0.42 μm, respectively. At 1 year, the mean values decreased significantly to 2.59 ± 1.06 μm, 2.42 ± 1.07 μm, 2.39 ± 1.07 μm, 0.88 ± 0.49 μm, and 0.83 ± 0.38 μm, respectively (all P=.01). After CXL, HOAs were significantly improved compared with the control group. Changes in HOAs were not statistically associated with an improvement in visual acuity or most subjective visual symptoms, however. Conclusion: Corneal and ocular HOAs decreased after CXL, suggesting an improvement in corneal shape. Financial Disclosure: Dr. Hersh is medical monitor for Avedro, Inc. No author has a financial or proprietary interest in any material or method mentioned. [ABSTRACT FROM AUTHOR]