Management of corneal ectasia after LASIK with combined, same-day, topography-guided partial transepithelial PRK and collagen cross-linking: the athens protocol.
OBJECTIVE
To evaluate a series of patients with corneal ectasia after LASIK that underwent the Athens Protocol: combined topography-guided photorefractive keratectomy (PRK) to reduce or eliminate induced myopia and astigmatism followed by sequential, same-day ultraviolet A (UVA) corneal collagen cross-linking (CXL).


METHODS
Thirty-two consecutive corneal ectasia cases underwent transepithelial PRK (WaveLight ALLEGRETTO) immediately followed by CXL (3 mW/cm(2)) for 30 minutes using 0.1% topical riboflavin sodium phosphate. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), manifest refraction spherical equivalent, keratometry, central ultrasonic pachymetry, corneal tomography (Oculus Pentacam), and endothelial cell counts were analyzed. Mean follow-up was 27 months (range: 6 to 59 months).


RESULTS
Twenty-seven of 32 eyes had an improvement in UDVA and CDVA of 20/45 or better (2.25 logMAR) at last follow-up. Four eyes showed some topographic improvement but no improvement in CDVA. One of the treated eyes required a subsequent penetrating keratoplasty. Corneal haze grade 2 was present in 2 eyes.


CONCLUSIONS
Combined, same-day, topography-guided PRK and CXL appeared to offer tomographic stability, even after long-term follow-up. Only 2 of 32 eyes had corneal ectasia progression after the intervention. Seventeen of 32 eyes appeared to have improvement in UDVA and CDVA with follow-up >1.5 years. This technique may offer an alternative in the management of iatrogenic corneal ectasia.
LaserVision.gr Institute, Athens, Greece. ajkmd@mac.com
Anastasios John
AJ
Kanellopoulos
Perry S
PS
Binder
D000328:Adult; D003094:Collagen / Q000378:metabolism* / Q000528:radiation effects; D003316:Corneal Diseases / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D019781:Corneal Topography / Q000379:methods*; D003432:Cross-Linking Reagents; D004108:Dilatation, Pathologic; D019573:Epithelium, Corneal / Q000473:pathology* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D020731:Keratomileusis, Laser In Situ / Q000009:adverse effects*; D008297:Male; D009216:Myopia / Q000601:surgery; D018903:Photorefractive Keratectomy / Q000379:methods*; D011183:Postoperative Complications; D013997:Time Factors; D014467:Ultraviolet Therapy / Q000379:methods
D003432:Cross-Linking Reagents; D003094:Collagen