Bowman layer implantation: an alternative to penetrating or deep anterior lamellar keratoplasty in eyes with advanced keratoconus

Abstract

 

Purpose

 

To evaluate the efficacy of Bowman layer (BL) implantation in reducing and stabilizing corneal ectasia in patients with advanced keratoconus (AKC) and contact lens intolerance, not eligible for either UV-crosslinking (UVCXL) or intracorneal ring segments (ICRS).

 

Methods

 

Ten eyes of 9 patients with AKC and contact lens intolerance, not candidates for either UVCXL or ICRS, underwent mid-stromal implantation of an isolated Bowman membrane and were followed for a mean duration of 16 months.

 

Results

 

All surgeries were uneventful and no complications related to BL implantation were observed. Maximum corneal power decreased, on average, from 74.5D (±7.1D) to 68.3D (±5.6D) (P=0.00). No changes in best corrected visual acuity (P=0.77) or pachymetry (P=0.11) were discovered, and contact lens tolerance was restored in all eyes.

 

Conclusions

 

For eyes with AKC, not candidates for either UVCXL or ICRS, BL implantation may be a safe and effective method of treating ectasia, enabling continued contact lens wear and postponing penetrating or deep anterior lamellar keratoplasty.

 

 

Slitlamp pictures of an eye at 6 months after Bowman layer implantation. The Bowman layer transplant (white arrows) is visible as a thin line within the recipient stroma, without any interface haze or stromal reaction.

 

 

Scheimpflug images of an eye (A) before and (B) at and twelve months after surgery. (C) When both images are superimposed, the corneal surface contour shows flattening and a better regularity after isolated Bowman layer implantation.

 

Keywords: 479 cornea: clinical science • 484 cornea: stroma and keratocytes • 765 wound healing