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Original Article

Management of Corneal Ectasia After LASIK With Combined, Same-day, Topography-guided Partial Transepithelial PRK and Collagen Cross-linking: The Athens Protocol

Anastasios John Kanellopoulos, MD; Perry S. Binder, MS, MD

PURPOSE

To evaluate a series of patients with corneal ectasia after LASIK that underwent the Athens Protocol: combined topography-guided photorefractive keratectomy (PRK) to reduce or eliminate induced myopia and astigmatism followed by sequential, same-day ultraviolet A (UVA) corneal collagen cross-linking (CXL).

METHODS

Thirty-two consecutive corneal ectasia cases underwent transepithelial PRK (WaveLight ALLEGRETTO) immediately followed by CXL (3 mW/cm²) for 30 minutes using 0.1% topical riboflavin sodium phosphate. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), manifest refraction spherical equivalent, keratometry, central ultrasonic pachymetry, corneal tomography (Oculus Pentacam), and endothelial cell counts were analyzed. Mean follow-up was 27 months (range: 6 to 59 months).

RESULTS

Twenty-seven of 32 eyes had an improvement in UDVA and CDVA of 20/45 or better (2.25 logMAR) at last follow-up. Four eyes showed some topographic improvement but no improvement in CDVA. One of the treated eyes required a subsequent penetrating keratoplasty. Corneal haze grade 2 was present in 2 eyes.

CONCLUSIONS

Combined, same-day, topography-guided PRK and CXL appeared to offer tomographic stability, even after long-term follow-up. Only 2 of 32 eyes had corneal ectasia progression after the intervention. Seventeen of 32 eyes appeared to have improvement in UDVA and CDVA with follow-up >1.5 years. This technique may offer an alternative in the management of iatrogenic corneal ectasia. [J Refract Surg. 2011;27(5):323-331.]

doi:10.3928/1081597X-20101105-01

ABOUT THE AUTHOR

From LaserVision.gr Institute, Athens, Greece (Kanellopoulos); New York University Medical College (Kanellopoulos) and Manhattan Eye, Ear and Throat Hospital (Kanellopoulos), New York, New York; and Gavin Herbert Eye Institute Department of Ophthalmology, University of California, Irvine, California (Binder).

The authors have no financial interest in the materials presented herein.

Presented as a paper at the American Society of Cataract and Refractive Surgery annual meeting; April 9-14, 2010; Boston, Massachusetts.

Correspondence: A. John Kanellopoulos, MD, LaserVision.gr Institute, 17 Tsocha St, Athens, 11521 Greece. Tel: 30 210 7472777; Fax: 30 210 7472789; E-mail: ajkmd@mac.com

Received: April 20, 2010; Accepted: October 13, 2010

Posted online: November 5, 2010