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Bowman's layer onlay grafting: new technique to flatten the corneal curvature and reduce progression in keratoconus

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First Author: I.Dapena THE NETHERLANDS

Co Author(s):    L. van de Star   E. Groeneveld-van Beek   K. van Dijk   J. Parker   S. Oellerich   G. Melles     

Abstract Details

Purpose:

To describe a new surgical technique for flattening the corneal curvature and to halt progression in eyes with advanced progressive keratoconus by using Bowman layer (BL) onlay grafting, and to report on the preliminary outcomes of this procedure.

Setting:

Prospective, interventional case series conducted at the Netherlands Institute for Innovative Ocular Surgery. NIIOS (Netherlands Institute for Innovative Ocular Surgery)

Methods:

Five patients with advanced progressive keratoconus underwent Bowman layer 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 one case, BL onlay grafting could be performed immediately after UV-Crosslinking; all other eyes were ineligible for UV-crosslinking. Best spectacle- and/or best contact lens-corrected visual acuity (BSCVA/BCLVA), refraction, biomicroscopy, corneal tomography, anterior segment optical coherence tomography and complications were recorded at 1 week, and 1, 3, 6 and 9 months postoperatively.

Results:

All five surgeries could be performed successfully. Average Kmax decreased from 75D preoperatively to 69D at the most recent evaluation (range 4-9 months). All eyes showed a completely re-epithelialized and a well-integrated graft. BSCVA improved at least 1 line (or more) in 3/5 cases. BCLVA remained stable, improving by 2 lines in case 1 at 6 months postoperatively. Satisfaction was high and all eyes again had full contact lens tolerance.

Conclusions:

BL onlay grafting may be a feasible surgical technique, providing up to -6D of corneal flattening in eyes with advanced keratoconus.

Financial Disclosure:

... receives consulting fees, retainer, or contract payments from a competing company