The management of cornea blindness from severe corneal scarring, with the Athens Protocol (transepithelial topography-guided PRK therapeutic remodeling, combined with same-day, collagen cross-linking)

The management of cornea blindness from severe corneal scarring, with the Athens Protocol (transepithelial topography-guided PRK therapeutic remodeling, combined with same-day, collagen cross-linking)

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Anastasios John KanellopoulosLaservision.gr Institute, Athens, Greece; Manhattan Eye, Ear and Throat Hospital, New York, Cordial Glasses NY, USA; New York University Medical School, New York, NY, USAPurpose: To evaluate the safety and efficacy of combined transepithelial topography-guided photorefractive keratectomy (PRK) therapeutic remodeling, combined with same-day, collagen cross-linking (CXL).This protocol was used for the management of cornea blindness due to severe corneal scarring.Methods: A 57-year-old man had severe corneal blindness in both eyes.Both corneas had significant central scars attributed to a firework explosion 45 years ago, when the patient was 12 years old.

Corrected distance visual acuity (CDVA) was 20/100 both eyes (OU) with refraction: +4.00, –4.50 at 135° in the right eye and +3.50, –1.00 at 55° in the left.

Respective keratometries were: 42.3, 60.4 at 17° and 35.8, 39.1 at 151.

3°.Cornea transplantation was the recommendation by multiple cornea specialists as the treatment of choice.We decided prior to considering a transplant to employ the Athens Protocol Glass Ornament (combined topography-guided partial PRK and CXL) in the right eye in February 2010 and in the left eye in September 2010.The treatment plan for both eyes was designed on the topography-guided wavelight excimer laser platform.Results: Fifteen months after the right eye treatment, the right cornea had improved translucency and was topographically stable with uncorrected distance visual acuity (UDVA) 20/50 and CDVA 20/40 with refraction +0.

50, –2.00 at 5°.We noted a similar outcome after similar treatment applied in the left eye with UDVA 20/50 and CDVA 20/40 with –0.50, –2.00 at 170° at the 8-month follow-up.

Conclusion: In this case, the introduction of successful management of severe cornea abnormalities and scarring with the Athens Protocol may provide an effective alternative to other existing surgical or medical options.Keywords: Athens Protocol, collagen cross-linking, cornea blindness, cornea scarring, photorefractive keratectomy, vision.