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    Ten-year data promising in combined CXL approach for keratoconus

    Athens Protocol appears safe, effective, predictable alternative in progressive cases


    Eyes treated for keratoconus with collagen crosslinking (CXL) combined with topography-guided excimer normalization maintain ectasia stability and good visual acuity with 10 years follow-up, according to researchers.

    “Patients show a very dramatic improvement in their visual function,” said Joanna Kontari, MD, of LaserVision Clinical and Research Eye Institute in Athens, Greece.

    Uncorrected distance visual acuity improved from 0.19 (decimal) at baseline to 0.53 (decimal) at 1 year on the decimal scale (where 1.0 is the equivalent of 20/20 and 0.1 is the equivalent of 20/200 on the Snellen scale). Their acuity was virtually unchanged at 10 years, reaching 0.55 (decimal) (Table 1).

    Best-corrected visual acuity went from 0.59 at baseline to 0.80 at 1 year and stayed at 0.81 10 years later.

    Keratoconus is a degenerative bilateral disorder characterized by corneal steepening, thinning and irregular topography that can cause refractive errors. CXL strengthens the cornea to halt this ectasia.

    However, significant residual astigmatism may limit visual rehabilitation, and when contact lens wear is not tolerable, patients may benefit from an additional procedure that normalizes the anterior surface.

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