PURPOSE: To evaluate a series of patients with corneal ectasia after LASIK that 
underwent the Athens Protocol: combined topography-guided photorefractive 
keratectomy (PRK) to reduce or eliminate induced myopia and astigmatism followed 
by sequential, same-day ultraviolet A (UVA) corneal collagen cross-linking 
(CXL).
METHODS: Thirty-two consecutive corneal ectasia cases underwent transepithelial 
PRK (WaveLight ALLEGRETTO) immediately followed by CXL (3 mW/cm(2)) for 30 
minutes using 0.1% topical riboflavin sodium phosphate. Uncorrected distance 
visual acuity (UDVA), corrected distance visual acuity (CDVA), manifest 
refraction spherical equivalent, keratometry, central ultrasonic pachymetry, 
corneal tomography (Oculus Pentacam), and endothelial cell counts were analyzed. 
Mean follow-up was 27 months (range: 6 to 59 months).
RESULTS: Twenty-seven of 32 eyes had an improvement in UDVA and CDVA of 20/45 or 
better (2.25 logMAR) at last follow-up. Four eyes showed some topographic 
improvement but no improvement in CDVA. One of the treated eyes required a 
subsequent penetrating keratoplasty. Corneal haze grade 2 was present in 2 eyes.
CONCLUSIONS: Combined, same-day, topography-guided PRK and CXL appeared to offer 
tomographic stability, even after long-term follow-up. Only 2 of 32 eyes had 
corneal ectasia progression after the intervention. Seventeen of 32 eyes 
appeared to have improvement in UDVA and CDVA with follow-up >1.5 years. This 
technique may offer an alternative in the management of iatrogenic corneal 
ectasia.