Cornea receives the densest small fiber innervation of the body. Keratoconus is an ectatic disease and the most common form of corneal thinning disorder. Corneal collagen cross-linking (CXL) and photorefractive keratectomy (PRK) are the most widely used therapeutic procedures in which postoperative pain management has been a major challenge. Herein we aimed to evaluate and compare the level of pain and the epithelial defect healing rate between the CXL and PRK treated groups.

68 patients visiting the ophthalmology clinic from April 2014 to May 2015 were enrolled. The PRK group consisted of 34 patients with simple refractive errors whereas the CXL group includedother 34 patients with clinical keratoconus. Patients in both groups were examined and compared regarding the level of pain (based on the visual analogue scale (VAS), verbal rating scale (VRS) and Faces pain scale), and epithelial defect (ED) size immediately after surgery and also 6 hours, one day, three days and seven days after the surgical procedure.

Mean age of patients in the PRK and CXL group was 29±1.19 and 28±0.73 years, respectively. ED size in the CXL group was significantly lower than the PRK group in both eyes on the first post-operative day (P<0.001). The amount of pain experienced by the patient was statistically different regarding the type of surgery (p=0.04 and p=0.019) and the follow up time (p<0.001) based on VAS and VRS, respectively. Yet, According to Faces, the patients’ pain was only influenced by the “follow up visit” time (p<0.001). No intra- or postoperative adverse events were observed.

Our findings showed a significantly faster ED healing rate on the first post-op day in the CXL group compared to the PRK group. However, the level of pain experienced was greater in the CXL group.