PURPOSE: To evaluate the safety and efficacy of combined transepithelial 
topography-guided photorefractive keratectomy (PRK) therapeutic remodeling, 
combined with same-day, collagen cross-linking (CXL). This protocol was used for 
the management of cornea blindness due to severe corneal scarring.
METHODS: A 57-year-old man had severe corneal blindness in both eyes. Both 
corneas had significant central scars attributed to a firework explosion 45 
years ago, when the patient was 12 years old. Corrected distance visual acuity 
(CDVA) was 20/100 both eyes (OU) with refraction: +4.00, -4.50 at 135° in the 
right eye and +3.50, -1.00 at 55° in the left. Respective keratometries were: 
42.3, 60.4 at 17° and 35.8, 39.1 at 151.3°. Cornea transplantation was the 
recommendation by multiple cornea specialists as the treatment of choice. We 
decided prior to considering a transplant to employ the Athens Protocol 
(combined topography-guided partial PRK and CXL) in the right eye in February 
2010 and in the left eye in September 2010. The treatment plan for both eyes was 
designed on the topography-guided wavelight excimer laser platform.
RESULTS: Fifteen months after the right eye treatment, the right cornea had 
improved translucency and was topographically stable with uncorrected distance 
visual acuity (UDVA) 20/50 and CDVA 20/40 with refraction +0.50, -2.00 at 5°. We 
noted a similar outcome after similar treatment applied in the left eye with 
UDVA 20/50 and CDVA 20/40 with -0.50, -2.00 at 170° at the 8-month follow-up.
CONCLUSION: In this case, the introduction of successful management of severe 
cornea abnormalities and scarring with the Athens Protocol may provide an 
effective alternative to other existing surgical or medical options.