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Updated: Jan 23, 2026

Three Different Protocols of Corneal Collagen Crosslinking in Keratoconus: Conventional, Accelerated and Iontophoresis
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Long-Term Stability With the Athens Protocol (Topography-Guided Partial PRK Combined With Cross-Linking) in Pediatric

Anastasios John Kanellopoulos1,2, Filippos Vingopoulos1, Anna Maria Sideri1

  • 1LaserVision Clinical and Research Eye Institute, Athens, Greece.

Cornea
|June 7, 2019
PubMed

Insights

The Athens Protocol (topography-guided partial PRK with corneal cross-linking) safely and effectively treats pediatric keratoconus, improving vision and corneal shape over four years.

Area of Science:

  • Ophthalmology
  • Corneal Surgery
  • Pediatric Eye Care

Background:

  • Keratoconus progression in pediatric patients requires effective treatment.
  • The Athens Protocol combines topography-guided partial PRK with corneal cross-linking (CXL).

Purpose of the Study:

  • To evaluate the safety, efficacy, and stability of the Athens Protocol in pediatric keratoconus patients.
  • Assess outcomes over a 4-year follow-up period.

Main Methods:

  • Prospective study of 39 eyes in 21 pediatric patients with progressive keratoconus.
  • All patients underwent topography-guided partial PRK and high-fluence CXL (Athens Protocol).
  • Evaluated visual acuity, refraction, keratometry, and corneal imaging for 4 years.

Main Results:

  • Significant improvements in uncorrected and corrected distance visual acuity observed.
  • Reduced keratometry readings (K1, K2, Kmax) and improved index of height decentration.
  • Two cases of late-onset deep corneal haze occurred, a potential complication.

Conclusions:

  • The Athens Protocol demonstrates safety and efficacy in pediatric keratoconus management.
  • The procedure leads to marked improvements in visual function and keratometric indices.
  • Long-term stability of the Athens Protocol in pediatric patients is supported.
Abstract

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