Midstromal isolated Bowman layer graft for reduction of advanced keratoconus: a technique to postpone penetrating or deep anterior lamellar keratoplasty

JAMA Ophthalmol. 2014 Apr 1;132(4):495-501. doi: 10.1001/jamaophthalmol.2013.5841.

Abstract

Midstromal implant of an isolated Bowman layer graft is a new approach to reduce ectasia in eyes with advanced keratoconus. The procedure should postpone penetrating or deep anterior lamellar keratoplasty. Ten eyes of 9 patients with progressive, advanced keratoconus and contact lens intolerance underwent the procedure with no intraoperative adverse events. Throughout the study period, we observed no complications related to stromal dissection and/or the Bowman layer graft. Maximum corneal power decreased from a mean (SD) of 74.5 (7.1) diopters (D) before to 68.3 (5.6) D after surgery (P = .002). Hence, implant of an isolated Bowman layer graft may offer a safe and effective new technique to reduce ectasia in eyes with advanced keratoconus, potentially allowing continued long-term contact lens wear. The low risk of complications may render the procedure suitable as a treatment to postpone penetrating or deep anterior lamellar keratoplasty in cases with impending contact lens intolerance and/or corneal scarring (clinicaltrials.gov Identifier: NCT01686906).

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Bowman Membrane / surgery*
  • Corneal Pachymetry
  • Corneal Stroma / surgery*
  • Corneal Topography
  • Corneal Transplantation
  • Female
  • Humans
  • Keratoconus / diagnosis
  • Keratoconus / surgery*
  • Keratoplasty, Penetrating
  • Male
  • Refraction, Ocular / physiology
  • Surgical Flaps*
  • Tissue Donors
  • Tissue Transplantation*
  • Tomography, Optical Coherence
  • Visual Acuity / physiology
  • Young Adult

Associated data

  • ClinicalTrials.gov/NCT01686906