New technique shows promise in advanced keratoconus

Bowman’s layer graft can lead to immediate flattening of corneal curvature

Roibeard O’hEineachain

Posted: Sunday, February 23, 2020

Grafting a donor Bowman’s layer on to a keratoconic cornea can result in an immediate flattening of the corneal curvature and stabilisation or improvement of patients’ visual acuity, said Isabel Dapena MD, The Netherlands Institute for Innovative Ocular Surgery, Rotterdam, the Netherlands.

The new surgical technique involves first removing the epithelium and then placing the Bowman’s layer on to the stroma and stretching it so that there are no folds. Afterwards a bandage layer is covered with a bandage contact lens, she told the 24th ESCRS Winter Meeting in Marrakech, Morocco.

Dr Dapena and her associates performed Bowman’s layer grafting in five patients with advanced progressive keratoconus, including one case that had undergone corneal cross-linking (CXL) immediately previously. The remaining four patients were unsuitable candidates for CXL.

She noted that all surgeries were performed successfully, with an immediate flattening of the corneal curvature postoperatively. At one-to-six months follow-up the average Kmax decreased from 74.9D preoperatively to 69.1D. In addition, all eyes were completely re-epithelialised with well-integrated graft.

Furthermore, at six months, best spectacle-corrected visual acuity (BSCVA) had improved by five lines and best contact lens corrected visual acuity improved by two lines in one patient who had preoperative central scarring. In two cases with two and three months’ follow-up BSCVA remained unchanged. Moreover, satisfaction was high and all eyes regained full contact lens tolerance.