Purpose. To evaluate effectiveness of simultaneous topography-guided photorefractive keratectomy and corneal collagen cross-linking in mild and moderate keratoconus. Methods. Prospective nonrandomized interventional study including 20 eyes of 14 patients with grade 1-2 keratoconus that underwent topography-guided PRK using a Custom Ablation Transition Zone (CATz) profile with 0.02% MMC application immediately followed by standard 3 mw/cm2 UVA collagen cross-linking. Maximum ablation depth did not exceed 58 μm. Follow-up period: 12 months. Results. Progressive statistically significant improvement of UCVA from 0.83±0.37 logMAR preoperative, reaching 0.25±0.26 logMAR at 12 months (P<0.001). Preoperative BCVA (0.27±0.31 logMAR) showed a progressive improvement reaching 0.08±0.12 logMAR at 12 months (P=0.02). Mean Kmax reduced from 48.9±2.8 to 45.4±3.1 D at 12 months (P<0.001), mean Kmin reduced from 45.9±2.8 D to 44.1±3.2 D at 12 months (P<0.003), mean keratometric asymmetry reduced from 3.01±2.03 D to 1.25±1.2 D at 12 months (P<0.001). The safety index was 1.39 at 12 months and efficacy index 0.97 at 12 months. Conclusion. Combined topography-guided PRK and corneal collagen cross-linking are a safe and effective option in the management of mild and moderate keratoconus. Precis. To our knowledge, this is the first published study on the use of the CATz ablation system on the Nidek Quest excimer laser platform combined with conventional cross-linking in the management of mild keratoconus.