Ten-Year Outcomes of Progressive Keratoconus Management With the Athens Protocol (Topography-Guided Partial-Refraction PRK Combined With CXL)

J Refract Surg. 2019 Aug 1;35(8):478-483. doi: 10.3928/1081597X-20190627-01.

Abstract

Purpose: To report the safety and long-term efficacy of topography-guided partial-refraction PRK combined with corneal cross-linking (CXL) (the Athens Protocol), refractive, topographic, and pachymetric changes of keratoconic eyes treated were studied.

Methods: Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), refraction, keratometry, qualitative and quantitative assessment of corneal keratometric, and pachymetric properties recorded by topography and tomography were evaluated for 10 years postoperatively.

Results: A total of 144 eyes were followed up for a mean 128 ± 4 months (range: 120 to 146 months). Mean UDVA markedly improved at 1 year (0.19 ± 0.17 to 0.53 ± 0.21 decimal) with further improvement to 0.55 ± 0.19 decimal at 10 years. CDVA increased from 0.59 ± 0.21 to 0.80 ± 0.17 decimal at 1 year and further to 0.81 ± 0.19 decimal at 10 years. Corneal thickness decreased from 468.74 ± 35.05 to 391.14 ± 40.07 μm at 1 year (P < .01) and up to 395.42 ± 32.21 μm at 10 years. Steep keratometry decreased from 50.57 ± 2.80 to 45.87 ± 2.70 diopters (D) (P < .01) at 1 year and to 44.00 ± 3.22 D at 10 years. Maximum keratometry decreased from 53.43 ± 2.97 to 46.17 ± 1.18 D at 1 year and 44.75 ± 2.14 D at 10 years (P < .01). A total of 94.4% demonstrated ectasia stabilization and 3.5% showed progressive "overcorrection" or "hyperopic" shift.

Conclusions: The Athens Protocol confirms long-term safety and efficacy for corneal ectasia and visual function. Most parameters had little change after 1 year, through year 10. [J Refract Surg. 2019;35(8):478-483.].

MeSH terms

  • Adult
  • Collagen / metabolism
  • Combined Modality Therapy
  • Corneal Stroma / drug effects
  • Corneal Stroma / metabolism
  • Corneal Topography
  • Cross-Linking Reagents*
  • Disease Progression
  • Female
  • Follow-Up Studies
  • Humans
  • Keratoconus / drug therapy
  • Keratoconus / physiopathology
  • Keratoconus / surgery
  • Keratoconus / therapy*
  • Lasers, Excimer / therapeutic use
  • Male
  • Middle Aged
  • Photochemotherapy / methods*
  • Photorefractive Keratectomy / methods*
  • Photosensitizing Agents / therapeutic use
  • Prospective Studies
  • Refraction, Ocular / physiology
  • Riboflavin / therapeutic use
  • Surgery, Computer-Assisted
  • Treatment Outcome
  • Ultraviolet Rays
  • Visual Acuity / physiology
  • Young Adult

Substances

  • Cross-Linking Reagents
  • Photosensitizing Agents
  • Collagen
  • Riboflavin