Epithelial remodeling after partial topography-guided normalization and high-fluence short-duration crosslinking (Athens protocol): Results up to 1 year

PurposeTo compare epithelial remodeling in keratoconic eyes that had photorefractive keratectomy and corneal collagen crosslinking (Athens protocol) with that in untreated keratoconic eyes and healthy eyes.SettingPrivate clinical practice, Athens, Greece.DesignComparative case series.MethodsFourier-domain anterior segment optical coherence tomography (AS-OCT) was used to obtain in vivo 3-dimensional epithelial thickness maps and center, superior, inferior, maximum, minimum, mean, midperipheral, and variability data.ResultsGroup A comprised 175 treated keratoconic eyes (Athens protocol); Group B, 193 untreated keratoconic eyes; and Group C, 160 healthy eyes. The 1-year mean center epithelial thickness in Group A was 47.78 μm ± 7.36 (SD) (range 33 to 64 μm). At the first clinical visit, it was 52.09 ± 6.80 μm (range 36 to 72 μm) in Group B and 52.54 ± 3.23 μm (range 45 to 59 μm) in Group C. The mean thickness range in Group A at 1 year was −19.94 ± 7.21 μm (range −6 to −34 μm). It was −21.83 ± 12.07 μm (range −4 to −66 μm) in Group B and −6.86 ± 3.33 μm (range −3 to −29 μm) in Group C. The mean topographic thickness variability in Group A at 1 year was 4.64 ± 1.63 μm (range 1.6 to 8.1 μm) (P<.05). It was 5.77 ± 3.39 μm (range 1.3 to 17.8 μm) in Group B and 1.59 ± 0.79 μm (range 0.6 to 5.6 μm) in Group C.ConclusionAnterior segment OCT indicated a thinner and more homogeneous remodeled epithelium in the keratoconic eyes treated using the Athens protocol.Financial DisclosureDr. Kanellopoulos is a consultant to Alcon Surgical, Inc.; Wavelight Laser Technologie AG; Avedro, Inc.; and i-Optics Optikgeräte GmbH. Dr. Asimellis has no financial or proprietary interest in any material or method mentioned.