Keratoconus Management: Long-Term Stability of Topography-Guided Normalization Combined With High-Fluence CXL Stabilization (The Athens Protocol)

Abstract

The Athens Protocol to arrest keratectasia progression and improve corneal regularity demonstrates safe and effective results as a keratoconus management option. Progressive potential for long-term flattening validates using caution in the surface normalization to avoid overcorrection.

Wave Front–Guided Photorefractive Keratectomy Using a High-Resolution Aberrometer After Corneal Collagen Cross-Linking in Keratoconus

“…14,[16][17][18][19][20][27][28][29] This is possibly due to the increased resolution of the Hartmann-Shack device used for measuring ocular aberrations that allows the characterization of large amounts of high-order aberrations. 27,30 When the results of our study using a sequential approach of CXL + WFG PRK are compared with the results reported by previous authors using the simultaneous approach, some variability is observed, with some authors reporting similar outcomes 17,18,[27][28][29] and others reporting worse results for the sequential procedure. 20 Kanellopoulos 20 compared the sequential and simultaneous approaches in corneas with keratoconus and found that same-day simultaneous topography-guided PRK and CXL seemed to be superior to sequential CXL with later PRK in the visual rehabilitation of progressing keratoconus.…”

Transepithelial versus epithelium-off crosslinking in adults with progressive keratoconus

“…38 Most recent studies used Scheimpflug technology. 12,39,40 We used a Scheimpflug-based topography system (Pentacam), as have other studies of transepithelial CXL, 9,12,14,16,17,19 and we preferred to include all quantitative descriptors of corneal topography.…”

Presbyopic PiXL Cross-Linking

“…The procedure known as the Athens Protocol (AP) [38] involves sequentially excimer laser epithelial debridement (50 lm), partial topography-guided excimer laser stromal ablation, and high-fluence UVA irradiation (10 mW/cm 2 ), accelerated (10 0 ) CXL. Early results [39] as well as anterior-segment optical coherence tomography quantitative findings [40] are indicative of the long-term stability of the procedure [41].…”