International Journal of Keratoconus and Ectatic Corneal Diseases

Register      Login

VOLUME 5 , ISSUE 2 ( May-August, 2016 ) > List of Articles


Simultaneous Topography-guided Surface Ablation with Collagen Cross-linking for Keratoconus

Igor Kaiserman, Lily Karmona, Tzahi Sela, Oz Franco, Avi Shoshani, Gur Munzer

Citation Information : Kaiserman I, Karmona L, Sela T, Franco O, Shoshani A, Munzer G. Simultaneous Topography-guided Surface Ablation with Collagen Cross-linking for Keratoconus. Int J Kerat Ect Cor Dis 2016; 5 (2):71-76.

DOI: 10.5005/jp-journals-10025-1124

Published Online: 01-12-2011

Copyright Statement:  Copyright © 2016; The Author(s).



In this article, we present the results of eight eyes of patients who underwent combined same-day partial topography-guided surface ablation followed by accelerated collagen cross-linking (CXL) procedure at Care-Vision Laser Centers to achieve stabilization of corneal ectasia and enhance visual rehabilitation in keratoconus.

Materials and methods

A retrospective nonrandomized review of 8 eyes of 6 patients who underwent the Athens Protocol for progressive keratoconus. Each patient underwent topography-guided ablation followed by CXL procedure.


Follow-up was done on day 1, day 7, and then at 1, 3, 6, and 12 months.


There was a rapid and significant improvement in uncorrected visual acuity and best-corrected visual acuity in 100% eyes, a reduction of keratometric values, and symmetry between vertical hemimeridians. Topographic evaluation showed a marked improvement in irregularity. There were no signs of keratoconic progression noted in any of the eyes on last follow-up. No adverse events were reported in any patient.


Simultaneous surface ablation + CXL seems to be a promising treatment capable of offering patients functional vision and halting progression of the disorder.


Simultaneous topography-guided custom ablation treatment and photorefractive keratectomy with CXL offers keratoconic patients intolerant to contact lenses both stabilization of the cornea and improved functional vision with spectacles correction.

How to cite this article

Karmona L, Sela T, Franco O, Shoshani A, Munzer G, Kaiserman I. Simultaneous Topography-guided Surface Ablation with Collagen Cross-linking for Keratoconus. Int J Kerat Ect Cor Dis 2016;5(2):71-76.

PDF Share
  1. Keratoconus. Surv Ophthalmol 1998 Jan-Feb;42(4):297-319.
  2. Management of keratoconus with Intacs. Am J Ophthalmol 2003 Jan;135(1):64-70.
  3. Riboflavin/ ultraviolet a crosslinking of the paracentral cornea. Cornea 2013 Feb;32(2):165-168.
  4. Flattening of the cornea after collagen crosslinking for keratoconus. J Cataract Refract Surg 2011 Aug;37(8):1488-1492.
  5. Marked remod- elling of the anterior corneal surface following collagen cross-linking with riboflavin and UVA. Br J Ophthalmol 2011 Aug;95(8):1171-1172.
  6. Management of corneal ectasia after LASIK with combined, same-day, topography-guided partial transepithelial PRK and collagen cross-linking: the athens protocol. J Refract Surg 2011 May;27(5):323-331.
  7. Comparison of sequential vs same-day simultaneous collagen cross-linking and topography-guided PRK for treatment of keratoconus. J Refract Surg 2009 Sep;25(9):S812-S818.
  8. Collagen cross-linking (CCL) with sequential topography-guided PRK: a temporizing alter- native for keratoconus to penetrating keratoplasty. Cornea 2007 Aug;26(7):891-895.
  9. Topography-guided surface ablation for forme fruste kerato- conus. Ophthalmology 2006 Dec;113(12):2198-2202.
  10. Stability of simultaneous topography-guided photorefractive keratectomy and ribo- flavin/UVA cross-linking for progressive keratoconus: case reports. J Refract Surg 2010 Oct;26(10):S827-S832.
  11. Safety and efficacy of simultane- ous corneal collagen cross-linking with topography-guided PRK in managing low-grade keratoconus: 1-year follow-up. J Refract Surg 2012 May;28(5):341-345.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.