PRoTECT: Corneal Wavefront Guided PRK + Epi-off CXL vs. PTK+Epi-off CXL in Keratoconus

Inclusion Criteria

• •Age 18-40 years
• •Diagnosis of keratoconus, ABCD Belin stage I-III at baseline
• •Minimum (thinnest) corneal pachymetry ≥ 450 µm pre-op
• •Written informed consent
• •Age-stratified progression requirements:
• •18-25 y: keratoconus stage I-III (progression not mandatory)
• •25-35 y: documented progression (meet ≥ 2 Table-1 criteria below) or, if recent documentation is absent, high-risk features for future progression: Kmax \> 53 D, strong family history, severe atopy with persistent eye rubbing, or any of the following over 12 months: ΔKmax ≥ 1.0 D, thinnest pachymetry decrease ≥ 10 µm, or increase in manifest cylinder ≥ 1.0 D
• •35-40 y: clear, unequivocal recent progression (meet ≥ 2 Table-1 criteria); late-onset documented progression may be considered