Mini Asymmetric Radial Keratotomy and Corneal Cross-linking for the Treatment and the Optical Rehabilitation of Keratoconus

JOURNAL TITLE: International Journal of Keratoconus and Ectatic Corneal Diseases

1. Gabriele Abbondanza
2. Marco Abbondanza
3. Valentina De Felice
Publishing Year
Author Affiliations
    1. Department of Surgery, Abbondanza Eye Center, Rome-Milan, Italy
    1. Department of Surgery, Abbondanza Eye Center, Rome Milan, Italy
    1. Department of Orthoptics, Abbondanza Eye Centres, Rome and Milan, Latium, Italy
  • Article keywords
    Corneal cross-linking, Keratoconus, Mini asymmetric radial keratotomy, Rome protocol


    Aim: To present and discuss the outcomes of the mini asymmetric radial keratotomy (MARK) and corneal cross-linking (CXL) combined intervention, also known as the “Rome protocol”, for patients with progressive stage I, II, and III keratoconus (KC) and contact lens intolerance (CLI). Design: Retrospective, observational study. Materials and methods: The postoperative outcomes of 48 eyes (35 patients) were selected and retrospectively analyzed, with an average follow-up of 3.8 years. To assess the efficacy of the MARK plus CXL combined protocol, mean keratometry, mean pachymetry, and best spectacle-corrected visual acuity were evaluated. Results: Mean keratometry improved in 90% of cases (from 48.3 D to 45 D), mean pachymetry improved in 83% of cases (from 439 to 460 μm), and best spectacle-corrected visual acuity improved in all cases (from +0.4 to +0.15 logMAR). Conclusion: The MARK plus CXL intervention effectively halted the KC progression and improved the visual acuity, which suggests that this combined procedure should be taken into account when considering refractive procedures combined with corneal cross-linking (CXL plus), if the relevant inclusion criteria can be satisfied.

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