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To describe the long-term result of the Athens protocol (custom topography-guided advanced surface ablation followed by riboflavin-UVA collagen crosslinking in the same day) for progressive advanced keratoconus in the left eye, while the fellow right eye first presented with relatively mild keratoconus that was treated with a more conservative therapeutic approach of continuous contact lenses use with the goal for ectasia stabilization. Five years after the Athens protocol, a regression of over 10 D (diopters) was observed on the sagittal curvature with significant regularization of corneal shape and improvement of distance corrected visual acuity (DVCA) in the left eye. The right eye, which was treated more conservatively, had an over 12 D increase on sagittal curvature along with significant distortion of the corneal shape and reduction of DCVA.

Long-term Improvement after the Athens Protocol for Advanced Keratoconus with Significant Ectasia Progression in the Fellow Eye