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

PURPOSE: To 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. SETTING: Private clinical practice, Athens, Greece. DESIGN: Comparative case series. METHODS: Fourier-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. RESULTS: Group 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 mu m +/- 7.36 (SD) (range 33 to 64 mu m). At the first clinical visit, it was 52.09 +/- 6.80 mu m (range 36 to 72 mu m) in Group B and 52.54 +/- 3.23 mu m (range 45 to 59 mu m) in Group C. The mean thickness range in Group A at 1 year was -19.94 +/- 7.21 mu m (range -6 to -34 mu m). It was -21.83 +/- 12.07 mu m (range -4 to -66 mu m) in Group B and 6.86 +/- 3.33 mu m (range -3 to -29 mu m) in Group C. The mean topographic thickness variability in Group A at 1 year was 4.64 +/- 1.63 mu m (range 1.6 to 8.1 mu m) (P<.05). It was 5.77 +/- 3.39 mu m (range 1.3 to 17.8 mu m) in Group B and 1.59 +/- 0.79 mu m (range 0.6 to 5.6 mu m) in Group C. CONCLUSION: Anterior segment OCT indicated a thinner and more homogeneous remodeled epithelium in the keratoconic eyes treated using the Athens protocol.