Isolated Bowman layer transplantation to manage persistent subepithelial haze after excimer laser surface ablation

In a 21-year-old patient with persistent dense subepithelial haze after photorefractive keratectomy, unresponsive to retreatment, a stromal flap, 9.0 mm in diameter and approximately 60 microm in thickness, was excised and an unsutured 9.0 mm donor Bowman layer was transplanted onto the stromal bed. The corrected distance visual acuity improved from 20/40 (0.5) before surgery to 20/18 (1.2) with a scleral-supported contact lens 2 months after transplantation. With optical coherence tomography, the transplanted Bowman layer was seen as a fine white line bordering the anterior host stroma. No recurrence of stromal haze was seen throughout the 6-month follow-up. Isolated Bowman layer transplantation may be a new technique for the management of anterior stromal opacities or complicated epithelial wound healing such as persistent corneal haze after excimer laser surface ablation.