Femtosecond laser-assisted Bowman layer transplantation for advanced keratoconus

Area of Science:

• Ophthalmology
• Corneal Surgery
• Biomedical Engineering

Background:

• Advanced progressive keratoconus often becomes ineligible for standard corneal crosslinking treatments.
• Surgical interventions are necessary to stabilize advanced keratoconus and prevent further vision loss.

Purpose of the Study:

• To evaluate the technical feasibility and clinical outcomes of femtosecond laser-assisted Bowman layer transplantation (FLABOLT).
• To assess FLABOLT's efficacy in stabilizing progressive, advanced keratoconus unsuitable for corneal crosslinking.

Main Methods:

• A retrospective analysis of 50 eyes from 49 patients with advanced keratoconus.
• Utilized femtosecond laser for both donor graft preparation and recipient mid-stromal pocket creation in FLABOLT.

Main Results:

• High technical success rates: 96% for graft preparation and 100% for pocket dissection.
• Mean maximum keratometry decreased by 1.93 D at 6 months; 92% of eyes remained stable without further intervention.
• Postoperative complications included transient hydrops in three eyes and one case of vision loss due to scarring requiring re-transplantation.

Conclusions:

• FLABOLT is a reproducible and effective surgical alternative for stabilizing advanced progressive keratoconus.
• Femtosecond laser assistance enhances precision in FLABOLT graft and pocket preparation.
• Longer-term studies are warranted to fully ascertain FLABOLT's long-term efficacy in advanced keratoconus management.