Late-Onset Stromal Scarring and Excessive Corneal Flattening After PRK–CXL in Keratoconus Suspects: A Report of Two Contralateral Case Variants

Purpose: To report two cases of late-onset central stromal scarring and marked corneal flattening following combined photorefractive keratectomy (PRK) and corneal collagen cross-linking (CXL) performed for keratoconus (KC) suspect, despite nearly identical bilateral preoperative characteristics and treatment parameters. Methods: Two patients underwent same-day PRK–CXL in both eyes for refractive correction in KC suspect elsewhere . Preoperative tomography, pachymetry, ablation profiles, ultraviolet fluence, and post operative[P1] [ab2] regimens were comparable between fellow eyes. Patients were followed with serial clinical examinations and corneal imaging. Results: In each patient, one eye developed late-onset central stromal scarring with excessive corneal flattening and reduced visual acuity, whereas the contralateral eye demonstrated stable healing and favorable visual outcomes. Conclusions: These cases illustrate marked inter-eye variability in corneal wound healing after PRK–CXL in KC suspects, emphasizing the need for careful patient selection, conservative treatment planning, and long-term follow-up. Ethical Compliance: All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards The authors declare that they have no financial, commercial, or proprietary interests in any product, device, or company mentioned in this manuscript, and no conflicts of interest relevant to the content of this article.