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Modified Athens Protocol treatment for keratoconus management: incorporation of cyclorotation and topography customised application of CXL irradiation

Poster Details

First Author: M.Chiridou GREECE

Co Author(s):    A. Kanellopoulos   G. Asimellis   S. Bourdou        

Abstract Details


To report a novel application of topographically-customized, variable fluence collagen crosslinking applied the same day following topographically customized PTK to achieve Keratoconus stabilization and maximize the refractive astigmatic symmetry changes in a keratoconic cornea with established progression.

Setting: Clinical and Research Eye Institute, Athens Greece


Topography-guided PTK treatment (maximum 40-μm) was applied initially followed by a 6.5-mm, 50-μm PTK treatment (epithelial debridement). Specially-formulated riboflavin transepithelial administration (0.02% MMC for 20-seconds and then 0.1% riboflavin for 5-minutes) and UV-A delivery was applied in an eye with progressive keratoconus. Customized variable-fluence pattern consisted of 15-J/cm2 in a small trapezoid area matched to the thinnest cornea, a broader trapezoid of 10-J/cm2 surrounded by a 7-mm round OZ of 5-J/cm2 energy. Fluence 45-mW/cm2, duration 6.5-minutes. Visual acuity, cornea clarity, keratometry, topography, and pachymetry with a multitude of modalities, as well as endothelial cell counts were evaluated over sixteen months.


Uncorrected Distance Visual Acuity (UDVA) changed from preoperative 20/80 to 20/25 at six months. A maximum astigmatic reduction of 7.8 D, and significant cornea surface normalization was achieved at one month and remained stable for 16 months postoperatively.


We introduce herein the novel application of a topographically-customizable variable fluence collagen crosslinking in progressive keratoconus in order to maximize the astigmatic refractive normalization effect and stabilize ectasia stabilization. This novel technique offers enhanced normalization refractive changes with less ablation in comparison to utilizing a homogeneous UV-A light beam for CXL in Athens Protocol cases. It potentially broadens the number of potential candidate cases that would have been limited to employ this technique due to tissue thickness limitations. FINANCIAL DISCLOUSRE: One or more of the authors travel has been funded, fully or partially, by a company producing, developing or supplying the product or procedure presented

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