Long-term outcomes of CXL, partial topo-guided PRK show efficacy, stability, safety

ATHENS, Greece — Ten-year outcomes of keratoconus management with the Athens protocol, consisting of combined partial topography-guided PRK and cross-linking, show quality and stability, according to the specialist who created this method.

“Over the last 13 years, we have treated over 3,000 cases and documented the long-term data of over 1,000 in the literature,” A. John Kanellopoulos, MD, said at the European Society of Cataract and Refractive Surgeons Winter Meeting.

Keratoconus is highly prevalent in Greece. In his practice in Athens, Kanellopoulos sees an average of 40 cases per week, many of which are intolerant to contact lenses because of the dry climate, sand and particles in the atmosphere.

He first performed the combined procedure in a patient who could not function visually after CXL.

“I started doing the forbidden, lasering a thin keratoconic cornea,” he said.

He emphasized that partial topography-guided PRK and CXL is not strictly speaking a refractive procedure, but rather a normalization procedure of the cornea combined with a stabilization procedure. Both are performed in the same session because they have a synergistic effect.

“What we obtain is not just 1 D with CXL and maybe 3 D with the laser correction, but all together a 10 D, 15 D, sometimes a 20 D flattening of the cornea. This could never be achieved by laser or CXL alone,” Kanellopoulos said.

Ten-year data show that most of the effect is achieved within the first year. Minor changes may occur later, and a few cases may over-flatten.

Kanellopoulos defined his technique as “an everyday tool to avoid corneal transplant in a young Greek, more often a boy on a ratio of 15-to-1 girl.”

A further evolution of the technique uses customized CXL, allowing for the removal of only 30 µm of tissue with the laser. Results will soon be published. – by Michela Cimberle

Reference:

Kanellopoulos AJ, et al. 10 year outcomes of CXL combined with partial topo-guided excimer laser (TGL) Athens protocol (AP) for keratoconus (KC). Presented at: ESCRS Winter Meeting; Feb. 15-17, 2019; Athens, Greece.

Disclosure: Kanellopoulos reports he is a consultant for Alcon, Avedro and Optovue.