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Therapeutic value of Bowman's layer onlay for two different types of superficial corneal disease

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First Author: R.AlSaady THE NETHERLANDS

Co Author(s):    I. Dapena   L. van der Star   K. van Dijk   G. Melles           

Abstract Details

Purpose:

To introduce the concept of using a Bowman layer (BL) onlay graft to manage superficial herpetic corneal scarring and epitheliopathy.

Setting:

Interventional case series conducted at the Netherlands Institute for Innovative Ocular Surgery.

Methods:

Three patients were included in our case series. The first two patients had a quiescent superficial corneal scar after herpetic (n=1) and varicella zoster (n=1) keratitis. The third patient suffered from recurrent corneal erosions due to map-dot-fingerprint dystrophy for which treatment with lubricants, (repeated) phototherapeutic keratectomy, (repeated) micropunctures, and a bandage lens were unsuccessful. All eyes underwent a BL onlay transplantation. Best spectacle-corrected visual acuity (BSCVA) and/or best contact lens-corrected VA (BCLVA), biomicroscopy, corneal tomography, anterior segment optical coherence tomography and possible complications were recorded.

Results:

Both surgical and postoperative courses were uneventful. An improvement of corneal clarity was observed. There was no virus re-activation or recurrence of epithelial erosions within the follow-up period (18 months for case 1,2 and 1 year for case 3). In case 1, the best corrected lens visual acuity (BCLVA) with a scleral lens improved from 10/100 (0.1) preoperatively to 20/32 (0.6) postoperatively. For case 2, no preoperative BCLVA was available, but a BCLVA of 20/36 (0.55) was achieved after the procedure. In case 3 the best corrected visual acuity (BCVA) pre-operatively was 20/100 (0.2) and improved to 20/32 (0.7) post-operatively.

Conclusions:

A BL onlay graft may be a feasible surgical procedure, which may have the potential to reduce superficial corneal surface issues, scarring and/or anterior corneal irregularities without resorting to deeper keratoplasty in these complex cases.

Financial Disclosure:

... gains financially from product or procedure presented, ... is employed by a for-profit company with an interest in the subject of the presentation