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Bowman layer transplantation: 5-year results.

Korine van Dijk1,2, Jack S Parker1,2,3, Lamis Baydoun1,2

  • 1Netherlands Institute for Innovative Ocular Surgery, Laan op Zuid 88, 3071 AA, Rotterdam, The Netherlands.

Graefe'S Archive for Clinical and Experimental Ophthalmology = Albrecht Von Graefes Archiv Fur Klinische Und Experimentelle Ophthalmologie
|February 16, 2018
PubMed
Summary

Bowman layer (BL) transplantation for advanced keratoconus shows stable corneal topography and visual acuity for 5 years. This procedure preserves contact lens tolerance, potentially delaying the need for penetrating or deep anterior lamellar keratoplasty.

Keywords:
Bowman layerCorneal transplantationDeep anterior lamellar keratoplastyKeratoconusProgressive ectasiaSurgical technique

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Area of Science:

  • Ophthalmology
  • Corneal Surgery
  • Regenerative Medicine

Background:

  • Advanced keratoconus significantly impacts vision and quality of life.
  • Current treatments aim to halt disease progression and restore visual function.
  • Bowman layer transplantation (BLT) is an emerging option for specific corneal conditions.

Purpose of the Study:

  • To evaluate the 5-year clinical outcomes of isolated Bowman layer (BL) transplantation.
  • To assess the efficacy of BLT in treating advanced keratoconus.
  • To determine the long-term safety and visual results of BLT.

Main Methods:

  • A prospective, single-center, interventional case series involving 20 eyes of 17 patients with advanced keratoconus.
  • Isolated BL grafts were inserted into a manually dissected mid-stromal pocket.
  • Evaluations included corneal tomography, visual acuities (BSCVA, BCLVA), endothelial cell density, and complications up to 5 years post-surgery.

Main Results:

  • Corneal keratometry (Kmean, Kmax) remained stable up to 5 years post-BLT, with an initial decrease observed.
  • Best corrected spectacle visual acuity (BSCVA) stabilized after an initial improvement; best corrected contact lens visual acuity (BCLVA) remained unchanged.
  • A high success rate of 84% at 5 years was estimated, with stable endothelial cell density and minimal complications (one case of corneal hydrops).

Conclusions:

  • Isolated BL transplantation leads to stable corneal topography and visual function for up to 5 years.
  • The procedure preserves contact lens tolerance, offering a potential alternative to more invasive surgeries.
  • BLT may allow for long-term postponement of penetrating or deep anterior lamellar keratoplasty in advanced keratoconus patients.