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Bowman’s layer transplantation technique postpones need for PK, DALK

BARCELONA —A Bowman’s layer graft intended to reduce advanced keratoconus may postpone the need for penetrating keratoplasty or deep anterior lamellar keratoplasty, according to a speaker at the EuCornea meeting.

The grafting technique was evaluated in a study conducted by Korine van Dijk, MD, and colleagues at the Netherlands Institute for Innovative Ocular Surgery (NIIOS).

“When the cornea becomes too thin or steep, and more keratoconic, new treatment options [for example, crosslinking and intrastromal corneal ring segment implantation] may not be possible anymore. And so today, the advanced keratoconus cases are simply allowed to progress with the chance of eventually needing corneal transplantation,” van Dijk said. “What has been lacking so far is a way to arrest ectasia in advanced keratoconus cases.”

The study included 22 eyes of 19 patients with progressive keratoconus who were not eligible for crosslinking or intrastromal corneal ring segments. Midstromal implantation of a donor Bowman’s layer was conducted. The technique has been reported in JAMA Ophthalmology.

Mean follow-up was 21 months, and eyes were assessed for best corrected visual acuity, corneal tomography and complications.

Intraoperative complications included two cases of Descemet’s membrane perforation in two eyes; postoperatively, there were no complications. There was no change in endothelial cell density after the technique.

“All included eyes showed a clear progression from before the surgery and then after the surgery. In the first month we saw a flattening of the cornea, which was followed by stabilization up to 2 years after the surgery,” she said.

Whereas spectacle corrected visual acuity improved significantly (P < .001), contact lens corrected visual acuity remained stable, van Dijk said.

Bowman’s layer transplantation can reduce and stabilize corneal ectasia in eyes with progressive advanced keratoconus and has a low risk for complications, thus potentially postponing the need for PK or DALK, according to van Dijk.

Disclosure: van Dijk reports no financial interest.

Reference: van Dijk K, et al. JAMA Ophthalmol. 2014;doi:10.1001/jamaophthalmol.2013.5841