To report a novel application of collagen cross-linking (CXL) in refractive astigmatic enhancement of previously performed astigmatic keratotomy. A 28-year-old woman with prior history of bioptics correction of high myopic astigmatism with femtosecond laser-assisted astigmatic keratotomy followed by topography-guided LASIK showed long-term regression of the astigmatism 4 years later. A novel CXL application was employed in an attempt to reverse the regression of the astigmatic keratotomy. The high fluence CXL intervention resulted in correction of 2 diopters of topographic and refractive cylinder. Uncorrected distance visual acuity changed from 20/50 to 20/20 and refraction from -0.50 -2.00 @ 90 to +0.25 -0.25 @ 90 at the 7-month follow-up. A possible novel application of high fluence CXL with refractive cornea effect is introduced. It may offer rapid and simple rehabilitation and its effect may be tapered.
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