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Management of progressive keratoconus with ray-tracing optimized PRK combined with CXL: The ray-tracing Athens Protocol

Poster Details

First Author: I. Kontari GREECE

Co Author(s):    A. Kanellopoulos                    

Abstract Details


To report a novel ray-tracing application of customization of excimer ablation for normalization of irregular corneas, combined with higher fluence CXL in the effective management and visual rehabilitation of progressive keratoconus

Setting: Clinical and Research Eye Institute


15 cases with progressive keratoconus was treated with CXL combined: with cornea surface normalization with a novel artificial intelligence platform that calculates the ablation profile from wavefront, Scheimpflug tomography of the cornea and anterior segment, and interferometry axial length data from a single diagnostic device, combined with higher fluence CXL (Athens Protocol). The software designs a model- eye based on intreferometry and traces 2000 rays to and from the eye with data. Visual function: Acuity, refractive error, cornea clarity, keratometry, topography, and pachymetry with a multitude of modalities, as well as endothelial cell density were evaluated over six months.


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. Uncorrected Distance Visual Acuity (UDVA) changed from preoperative 20/80 to 20/20 and 20/25 respectively measured at six months. A maximum astigmatic reduction of 7.8 D, average 3.8D, and significant cornea surface normalization (IHD improvement from 0.180 to 0.055) was achieved by one month and remained relatively stable for 6 months postoperatively.


We introduce herein the use of novel excimer laser customization for irregular corneal treatments such as keratoconus, employing several independent up-till-now diagnostics. It bears the potential advantage through total corneal aberration data and ray tracing calculation by artificial intelligence, to address normalization of the defected human eye optics, specific for each eye treated and not based on the standard Gullstrand model, when compared to normalizing the anterior corneal surface data alone.

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