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Vienna 2018 Delegate Registration Programme Exhibition Virtual Exhibition Satellites 2018 Survey


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Athens protocol after femtosecond-assisted intracorneal ring implantation

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Session Details

Session Title: Cross-Linking Protocols

Session Date/Time: Monday 24/09/2018 | 14:00-16:00

Paper Time: 14:40

Venue: Room A3, Podium 3

First Author: : J.Mello Amaral BRAZIL

Co Author(s): :    R. Ambrosio Jr   B. Lopes                 

Abstract Details


To report safety and efficacy on visual outcomes and manifest refraction after Athens Protocol (same day surface ablation + corneal crosslinking) in patients with ectasia who previously underwent femtosecond-assisted intrastromal corneal ring implantation (fs-ICRS).


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We evaluated forty-two eyes of 40 patients operated by the Athens Protocol in an interval of 15 days to 46 months after fs-ICRS with minimal follow-up of 1 month. Pre- and post-operative uncorrected distance visual acuity (UDVA), distance-corrected visual acuity (DCVA), and manifest refraction were retrospectively compared by non-parametric Friedman test. All eyes had ICRS position evaluated by FD-OCT prior to the Athens Protocol procedure in order to assure at least 200microns of residual stroma over the ICRS after ablation.


Complete epithelial healing was observed in all eyes within the first 7 days after Athens Protocol. No eye lost DCVA after Athens Protocol following fs-ICRS. All variables had a statistically significant improvement between the pre-operative and the last observation time-points (p<0.01). DCVA improved from logMAR0.44±0.2 to logMAR0.21±0.20 (p<0.00001), manifest astigmatism improved from -5.01±2.36 to -2.42 ±1.87(p<0.00001) and spherical equivalent improved from -6.07±4.92 to -3.33±3.87 (p=0.0007).


There is a synergistic additive effect of the Athens Protocol following fs-ICRS which was considered a safe and efficient procedure to improve visual acuity for patients with ectasia. Studies considering a longer follow-up are needed as guidelines for preoperative planning, in order to assure stromal thickness over the ICRS prior to Athens Protocol.

Financial Disclosure:

... receives consulting fees, retainer, or contract payments from a competing company

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