Management Of Progressive Keratoconus In The United States With Transepithelial 2-Step Phototherapeutic Keratectomy Combined With Cxl: The Us-Modified Athens Protocol Designed For Approved Excimer Specifications.
Published 2024 - 42nd Congress of the ESCRS
Reference: PP01.08 | Type: Free paper | DOI: 10.82333/9j7y-gy25
Authors: Despoina Karadimou* 1 , Athanasios Zisimopoulos 1 , Anastasios John Kanellopoulos 2
1Ophthalmology,LaserVision Ambulatory Eye Surgery Unit,Athens,Greece, 2Ophthalmology,LaserVision Ambulatory Eye Surgery Unit,Athens,Greece;Ophthalmology,NYU Med School,New York,United States
Purpose
To report a novel application of excimer ablation for normalization of irregular corneas, combined with higher fluence CXL in the effective management and visual rehabilitation of progressive keratoconus.
Setting
The Laservision Clinical and Research Institute, Athens, Greece
Methods
17 cases with progressive keratoconus were treated with CXL combined: with a corneal surface excimer laser ablation normalization in 2 steps: a topography-guided (Contura) myopic ablation placed over the intact epithelium to account for epithelial removal and cornea surface re-shaping, followed by, a second, wavefront-optimized hyperopic excimer treatment, aimed to complete the designed epithelial removal over a 9mm diameter. The 2 sequential excimer ablations were followed by the CXL part of the Athens protocol combined procedure. Refractive error and Visual function parameters: Acuity, cornea clarity, keratometry, topography, and pachymetry, as well as endothelial cell density were evaluated over 36 months.
Results
Keratoconus stabilized in all cases. The severity of keratoconus stage by Amsler-Krumeich criteria improved for the OD from an average 2.2 to 1. Mean UDVA showed marked improvement at one-year follow-up (0.21±0.18 to 0.51±0.25 decimal) with small additional improvement through the 3 years (0.51±0.16 decimal). CDVA respectively increased from 0.55±0.11 (decimal) to 0.79±0.16 (decimal) at 1 year and to 0.79±0.16 (decimal) at 3 years. Mean minimal corneal thickness decreased significantly from 466.74±34.25 μm to 396.17±45.17μm (P<.01) as recorded the first year postoperatively and then slightly increased to 405.17±32.21 μm at the 3-year follow-up.
Conclusions
We introduce herein initial clinical data with the use of novel off-label therapeutic excimer laser surface ablation application designed to perform both epithelial removal and anterior corneal stroma reshaping combined with CXL in order to employ the Athens Protocol within US excimer laser approved specifications.