title: Epithelial remodeling after partial topography-guided normalization and high-fluence short-duration crosslinking (Athens protocol): results up to 1 year.
abstract: OBJECTIVE
  To compare epithelial remodeling in keratoconic eyes that had photorefractive keratectomy and corneal collagen crosslinking (Athens protocol) with that in untreated keratoconic eyes and healthy eyes.
  
  
  METHODS
  Private clinical practice, Athens, Greece.
  
  
  METHODS
  Comparative case series.
  
  
  METHODS
  Fourier-domain anterior segment optical coherence tomography (AS-OCT) was used to obtain in vivo 3-dimensional epithelial thickness maps and center, superior, inferior, maximum, minimum, mean, midperipheral, and variability data.
  
  
  RESULTS
  Group A comprised 175 treated keratoconic eyes (Athens protocol); Group B, 193 untreated keratoconic eyes; and Group C, 160 healthy eyes. The 1-year mean center epithelial thickness in Group A was 47.78 μm ± 7.36 (SD) (range 33 to 64 μm). At the first clinical visit, it was 52.09 ± 6.80 μm (range 36 to 72 μm) in Group B and 52.54 ± 3.23 μm (range 45 to 59 μm) in Group C. The mean thickness range in Group A at 1 year was -19.94 ± 7.21 μm (range -6 to -34 μm). It was -21.83 ± 12.07 μm (range -4 to -66 μm) in Group B and -6.86 ± 3.33 μm (range -3 to -29 μm) in Group C. The mean topographic thickness variability in Group A at 1 year was 4.64 ± 1.63 μm (range 1.6 to 8.1 μm) (P<.05). It was 5.77 ± 3.39 μm (range 1.3 to 17.8 μm) in Group B and 1.59 ± 0.79 μm (range 0.6 to 5.6 μm) in Group C.
  
  
  CONCLUSIONS
  Anterior segment OCT indicated a thinner and more homogeneous remodeled epithelium in the keratoconic eyes treated using the Athens protocol.
  
  
  BACKGROUND
  Dr. Kanellopoulos is a consultant to Alcon Surgical, Inc.; Wavelight Laser Technologie AG; Avedro, Inc.; and i-Optics Optikgeräte GmbH. Dr. Asimellis has no financial or proprietary interest in any material or method mentioned.
authors.affiliation: From Laservision.gr Eye Institute (Kanellopoulos), Athens, Greece, and the New York University Medical School (Kanellopoulos, Asimellis), New York, New York, USA. Electronic address: ajk@brilliantvision.com.
authors.forename: Anastasios John
authors.initials: AJ
authors.lastname: Kanellopoulos
authors.affiliation: From Laservision.gr Eye Institute (Kanellopoulos), Athens, Greece, and the New York University Medical School (Kanellopoulos, Asimellis), New York, New York, USA.
authors.forename: George
authors.initials: G
authors.lastname: Asimellis
mesh_terms: D000293:Adolescent; D000328:Adult; D003094:Collagen / Q000378:metabolism*; D003131:Combined Modality Therapy; D063171:Corneal Pachymetry; D003319:Corneal Stroma / Q000378:metabolism; D019781:Corneal Topography; D003432:Cross-Linking Reagents / Q000627:therapeutic use*; D019573:Epithelium, Corneal / Q000502:physiology*; D005260:Female; D005583:Fourier Analysis; D006801:Humans; D007640:Keratoconus / Q000378:metabolism / Q000503:physiopathology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D018903:Photorefractive Keratectomy; D017319:Photosensitizing Agents / Q000627:therapeutic use*; D011446:Prospective Studies; D012256:Riboflavin / Q000627:therapeutic use; D041623:Tomography, Optical Coherence; D014466:Ultraviolet Rays
chemical_list: D003432:Cross-Linking Reagents; D017319:Photosensitizing Agents; D003094:Collagen; D012256:Riboflavin