Keratoconus Management With Customized Prk By Artificial Intelligence Ray-Tracing Optimization, Combined With Higher Fluence Cxl: The Ray-Tracing Athens Protocol Case Report

To report novel ray-tracing customization of the normalization excimer ablation, combined with higher fluence CXL, in the management and visual rehabilitation of progressive keratoconus.

the Laservision Clinical and Research Institute, Athens, Greece

A 28 year-old male with bilateral progressive keratoconus was treated with Athens Protocol: CXL combined with a photorefractive surface ablation customized by a novel artificial intelligence platform calculating low and high order aberrations based on wavefront, Scheimpflug tomography and interferometry axial length data from a single diagnostic device. Visual Acuity, refractive error, keratometry, OCT and Scheimplug tomography and  endothelial cell density were evaluated over twelve months. 

Keratoconus stabilized in both eyes. UDVA changed from 20/80 to 20/20 in the OD; and from 20/40 to 20/25 in the OS at twelve months.  Keratometry changes were: from 40.7 and 42.7 @ 165.1 degrees to 41.4, 43.1 @ 169.3 degrees for the OD and from 40.9, 42,6 @ 15.9 degrees to 44.1, 44,7 @ 9.8 degrees for the OS. Cornea surface normalization for the OD were: IHD from 0.115  to 0.099, ISV from 77 to 67.

For the OS the respective changes were; IHD from 0.066 to 0.014, and ISV from 49 to 31.

We introduce herein the management of progressive keratoconus with CXL combined with novel excimer laser customization employing several independent up-till-now diagnostics calculated by software, evaluating bi-directional theoretical ray-tracing. It bears the potential advantage of addressing more accurately normalization of the distorted human eye optics associated with corneal ectasia, compared to using anterior corneal surface data or wavefront data alone.