Bowman Layer Onlay Grafting: Proof-of-Concept of a New Technique to Flatten Corneal Curvature and Reduce Progression in Keratoconus.
Adult
Bowman Membrane
/ surgery
Cornea
/ diagnostic imaging
Corneal Pachymetry
/ methods
Corneal Topography
Corneal Transplantation
/ methods
Disease Progression
Female
Follow-Up Studies
Humans
Keratoconus
/ diagnosis
Male
Middle Aged
Prospective Studies
Refraction, Ocular
/ physiology
Tomography, Optical Coherence
/ methods
Visual Acuity
Journal
Cornea
ISSN: 1536-4798
Titre abrégé: Cornea
Pays: United States
ID NLM: 8216186
Informations de publication
Date de publication:
01 Dec 2021
01 Dec 2021
Historique:
received:
22
10
2020
accepted:
21
02
2021
pubmed:
17
4
2021
medline:
11
1
2022
entrez:
16
4
2021
Statut:
ppublish
Résumé
The aim of this study was to describe a new surgical technique for flattening the corneal curvature and to reduce progression in eyes with advanced progressive keratoconus (KC) by using Bowman layer (BL) onlay grafting and to report on the preliminary outcomes of this procedure. In this prospective interventional case series, 5 patients with advanced progressive KC underwent BL onlay grafting. After removal of the epithelium, a BL graft was placed and "stretched" onto the stroma, and a bandage lens was placed to cover the BL graft. In 1 case, BL onlay grafting could be performed immediately after ultraviolet corneal crosslinking; all other eyes were ineligible for ultraviolet corneal crosslinking. Best spectacle- and/or best contact lens-corrected visual acuity, refraction, biomicroscopy, corneal tomography, anterior segment optical coherence tomography, and complications were recorded at 1 week and at 1, 3, 6, 9, and 12 to 15 months postoperatively. All 5 surgeries could be performed successfully. Average maximum keratometry went from 75 diopters (D) preoperatively to 70 D at 1 year postoperatively. All eyes showed a completely reepithelialized and a well-integrated graft. Best spectacle-corrected visual acuity improved at least 2 Snellen lines (or more) in 3 of 5 cases and best contact lens-corrected visual acuity remained stable, improving by 3 Snellen lines in case 1 at 15 months postoperatively. Satisfaction was high, and all eyes again had full contact lens tolerance. BL onlay grafting may be a feasible surgical technique, providing up to -5 D of corneal flattening in eyes with advanced KC.
Identifiants
pubmed: 33859087
doi: 10.1097/ICO.0000000000002740
pii: 00003226-202112000-00009
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1561-1566Informations de copyright
Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
G. R. J. Melles is a consultant for DORC International/Dutch Ophthalmic USA and SurgiCube International. J. S. Parker is a consultant for DORC International/Dutch Ophthalmic USA and Ziemer Ophthalmic Systems. G. R. J. Melles has a patent application pending related to this manuscript. The remaining authors have no conflicts of interest to disclose.
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