Corneal refractive power and symmetry changes following normalization of ectasias treated with partial topography-guided PTK combined with higher-fluence CXL (the Athens Protocol).

PURPOSE: To investigate preoperative and postoperative anterior and posterior keratometry and simulated corneal astigmatism in keratoconic eyes treated with collagen cross-linking combined with anterior surface normalization by partial topography-guided excimer ablation (the Athens Protocol).

METHODS: Anterior and posterior corneal keratometry were measured by Scheimpflug imaging for 267 untreated keratoconic eyes. Following treatment, they were assessed 1 year postoperatively.

RESULTS: Before treatment, average anterior keratometric value was 47.06 ± 6.02 diopters (D) for flat and 51.24 ± 6.75 D for steep. The posterior keratometric values were -6.70 ± 0.99 D (flat) and -7.67 ± 1.15 D (steep). Anterior astigmatism was on average with-the-rule (-1.97 ± 6.21 D), whereas posterior astigmatism was against-the-rule (+0.53 ± 1.02 D). The posterior and anterior astigmatism were highly correlated (r(2) = 0.839). After treatment, anterior keratometric values were 43.97 ± 5.81 D (flat) and 46.55 ± 6.82 D (steep). Posterior keratometric values were -6.58 ± 1.05 D (flat) and -7.69 ± 1.22 D (steep). Anterior astigmatism was on average with-the-rule (-1.56 ± 3.80 D), whereas posterior astigmatism was against-the-rule (+0.45 ± 1.29 D). The statistically significant (P < .05) keratometric changes indicated anterior surface flattening -3.09 ± 2.67 D (flat) and -4.19 ± 2.96 D (steep). The posterior keratometric changes were not statistically significant (P > .05).

CONCLUSIONS: Before treatment, there was a strong correlation between posterior and anterior corneal astigmatism. After treatment, statistically significant anterior keratometric values flattened. The posterior surface keratometric values did not demonstrate statistically significant postoperative change: there was minimal posterior change, despite the significant anterior surface normalization.