Surface Excimer Laser Ablation Enhancements 6 Months To 2 Years In Progressive Keratoconus Treated Previously With Cxl Combined With Excimer Corneal Reshaping: The Athens `Protocol `Cxl

CXL has beensafe and effective in stabilizing ectasia associated with keratoconus. The AthensProtocol CXL appears to achieve dramatic corneal flattening through a synergistic effect of the minimaltherapeutic surface ablation combined with higher fluence CXL. The very long term outcomes result insignificant hyperopic refractive errors and anisometropia in some cases that can be addressed by anovel tranepithelial hyperopic surface ablation. we evaluated herein,the safety and efficacy ofsurfacerefractive ablationfollowing combined corneal crosslinking and excimer normalization (Athensprotocol)

LaserVision Ambulatory Eye Surgery Unit, Athens, Greece

In a consecutive case series a surface ablation was employed to treat residual refractiveerrorin KCN eyes that had been previously treated with the Athens Protocol CXL. Perioperative evaluationincluded visual acuity, refractive error, Scheimpflug and OCT corneal stroma and epitheliumtomography mapping , topography

53 keratoconuseyes previously treated with the Athens Protocol combined CXL wereevaluated over 15 years The mean refractive error changed from-4.25D to + 3.5D, steepestkeratometry flattened in average 8.5D (6 to 15), The residual refractive error was treated with a surfaceablation and epi-Bowman's blunt keratectomy (Orca device) epithelium removal. UDVA improved from20/70 to 20/30 and CDVA from 20/30 to 20/25 with a 14 month average follow-up (12-28)

The Athens Protocol CXL combined procedure for progressive keratoconus may in somecases acchieve remarkable synergistic long term keratoconus-related cornea flattening, that may betreated, in myopic spherical equivalent if central pachymetry permits, by a surface ablation. If thespherical equivalent is hyperopiceven in corneas with very thin central pachymetry by a hyperopicsurface ablation.