Bowman layer transplantation in the treatment of keratoconus

Several treatment options corresponding to the grade of keratoconus have been established. These are ultra-violet corneal crosslinking and intracorneal ring segments for mild to moderate keratoconus, and penetrating keratoplasty or deep anterior lamellar keratoplasty for the more advanced cases of keratoconus. Bowman layer transplantation was developed as a procedure for patients with advanced, progressive keratoconus. The technique consists of transplanting an isolated donor Bowman layer into a mid-stromal pocket of a keratoconic cornea resulting in corneal flattening and stabilization against further ectasia. Thus, it aims at corneal stabilization in eyes with advanced keratoconus, and enabling continued contact lens wear for normal visual functionality. By being a sutureless procedure and using an acellular graft, it potentially avoids commonly known suture and graft-related complications of penetrating or deep anterior lamellar keratoplasty. The treatment seems to be a promising option in the management of advanced keratoconus in order to postpone or prevent a more invasive corneal surgery, while minimizing the risk of complications and allowing less stringent surveillance and less intensive medical therapy.