Articoli Scientifici di Oftalmologia
Argomento : 2
The Athens Protocol
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P
rogressive, asymmetrical corneal steepening associated
with an increase in myopic and astigmatic
refractive errors, combined with midperipheral
and/or peripheral corneal thinning, represents a
constellation of findings in ectatic corneal disorders (eg, keratoconus
and pellucid marginal degeneration).
These entitites are associated with asymmetry upon presentation,
unpredictability of progression, and myriad abnormal
topographic findings. Similar observations after LASIK
surgery have been described as post-LASIK ectasia.
1-3
Analyses of series of eyes that have developed post-LASIK
ectasia have suggested that certain preoperative and/or
operative features may be associated with this adverse outcome
of LASIK or PRK.4
The fact that ectasia can occur in
the absence of these features, or that it may not occur in
spite of them, has confounded surgeons’ understanding of
this complication.5 Nevertheless, post-LASIK ectasia is a
visually disabling complication whose ultimate surgical
treatment is penetrating keratoplasty when glasses or contact
lenses can no longer provide patients with visual quality
that allows them to perform their activities of daily living.
During the past 10 years, the use of topical riboflavin
combined with ultraviolet-A (UVA) irradiation to increase
collagen cross-linking (CXL) has demonstrated the potential
for retarding or eliminating the progression of keratoconus
and post-LASIK ectasia. My colleagues and I have previously
reported on the application of CXL in post-LASIK ectasia.6
We have found that once the progression has stabilized, it is
possible to treat the surface of the eye with customized PRK
to normalize the corneal surface by reducing irregular astigmatism.
After using CXL for cases of ectasia, my colleagues
and I introduced the Athens Protocol, which consists of
same-day, topography-guided partial PRK and CXL.
