Background: Keratoconus is a progressive ectatic condition that is non-inflammatory, bilateral, and characterized by apical bulging and central corneal thinning. Aim: To evaluate simultaneous photorefractive keratectomy (PRK) and the visual outcomes of corneal collagen cross-linking (CXL) in eyes with suspected keratoconus. Patients and methods: This was a prospective, interventional, nonrandomized research of 30 eyes performed in the ophthalmology department of Al Azhar University (Assiut) and El Nahar Eye Centre in Assiut. Results: The mean values of UCVA, BCVA, manifest spherical, and cylinder significantly decreased after three and six months, respectively, with a p-value of less than 0.001. After 3 months, dry eye was documented in 16.67% of eyes, decreasing to 6.67% after 6 months. Mild corneal haze was reported in 13.333% of eyes after three months, with no cases after 6 months. Throughout the follow-up duration, a significant decrease was observed in keratometric astigmatism, keratometric "Steep", keratometric "Flat", Steepest Keratometric "Kmax", spherical equivalent refraction, CT at the thinnest location, and back elevation, with a p-value of 0.001. Conclusion: The combination of a customized CXL (accelerated protocol) and a pho-torefractive procedure (PRK) led to a persistent flattening impact and a significant regularization of keratoconic corneas, as well as an enhancement in BCVA over a six-month follow-up.