• Cxl Plus: the Stare- X Protocol Description: This CXL plus protocol was conceived combining the all surface laser ablation (ASLA) refractive surgery and the more advanced ACXL technology actually available to obtain a great improvement of HOA in ectatic cornea. First step: transepithelial excimer laser ablation. The procedure consists of single-step corneal topo- guided TRANS-PRK variable optical zone (OZ) . Trans-PRK with planning of partial refractive correction is influenced by pachymetry and spherical equivalent value. The most suitable patients for this treatment are those with spherical equivalent 450 µm. To limit the stromal ablation under the cone apex in the STARE-X protocol, we computed in the algorithm the central thickness value and the paracentral value corresponding to the thinnest point located on the cone apex, creating a customized epithelium removal ablation. The depth saving mode is always used. This is useful because the limited cylinder correction will be shifted toward the peripheral and thicker cornea. The target is to reduce stromal ablation under the cone during epithelium removal, with RST =350 µm. Second step: customized energy accelerated CXL protocol considers a high-irradiance fractionated UV-A irradiation of 12 min at 15 mw/cm 2 and 7.2 J energy dose delivered with KXL.Treatment planning must include the maximum posterior elevation cone for all the treatments. The riboflavin solution used is composed of dextran-free riboflavin 0.1% with hydroxyl, propyl, methyl and cellulose (VibeX Rapid, Avedro Inc., Waltham, MS, USA), with 10 min of corneal soaking. Subspecialty: Cornea / External Disease Level: Advanced Uploaded By: Miguel Rechichi