ESCRS - PP20.13 - Surface Excimer Laser Ablation Enhancements 6 Months To 2 Years In Progressive Keratoconus Treated Previously With Cxl Combined With Excimer Corneal Reshaping: The Athens `Protocol `Cxl

Surface Excimer Laser Ablation Enhancements 6 Months To 2 Years In Progressive Keratoconus Treated Previously With Cxl Combined With Excimer Corneal Reshaping: The Athens `Protocol `Cxl

Published 2022 - 40th Congress of the ESCRS

Reference: PP20.13 | Type: ESCRS 2022 - Posters | DOI: 10.82333/5r72-tc31

Authors: Anastasios John Kanellopoulos 1 , Dimtrios Machairas* 2

1Ophthalmology,LaserVision Ambulatory Eye Surgery Unit,Athens,Greece;Ophthalmology,NYU Med School,New York,United States, 2Ophthalmology, LaserVision Ambulatory Eye Surgery Unit,Athens,Greece

Purpose

CXL has been safe and effective in stabilizing ectasia associated with keratoconus. The Athens Protocol CXL appears to achieve dramatic corneal flattening through a synergistic effect of the minimal therapeutic surface ablation combined with higher fluence CXL. The very long term outcomes result in significant hyperopic refractive errors and anisometropia in some cases that can be addressed by a novel tranepithelial hyperopic surface ablation. we evaluated herein, the safety and efficacy of  surface refractive ablation following combined corneal crosslinking and excimer normalization (Athens protocol)

Setting

The Laservision Clinical and Research Institute, Athens, Greece

Methods

In a consecutive case series a surface ablation was employed to treat residual refractive error in KCN eyes that had been previously treated with the Athens Protocol CXL. Perioperative evaluation included visual acuity, refractive error, Scheimpflug and OCT corneal stroma and epithelium tomography mapping , topography.

Results

53 keratoconus eyes previously treated with the Athens Protocol combined CXL were evaluated over 15 years The mean refractive error changed from -4.25D to + 3.5D, steepest keratometry flattened in average 8.5D (6 to 15), The residual refractive error was treated with a surface ablation and epi-Bowman's blunt keratectomy (Orca device) epithelium removal. UDVA improved from 20/70 to 20/30 and CDVA from 20/30 to 20/25 with a 14 month average follow-up (12-28).

Conclusions

The Athens Protocol CXL combined procedure for progressive keratoconus may in some cases acchieve remarkable synergistic long term keratoconus-related cornea flattening, that may be treated, in myopic spherical equivalent if central pachymetry permits, by a surface ablation. If the spherical equivalent is hyperopic even in corneas with very thin central pachymetry by a hyperopic surface ablation.