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

Session Details

Session Title: Cornea & Miscellaneous
Session Date/Time: Saturday 22/02/2020 | 08:30-11:10
Paper Time: 09:49
Venue: Auditorium des Ministres.

First Author: I.Dapena THE NETHERLANDS
Co Author(s): L. Van de Star  E. Groeneveld  K. van Dijk  S. Oellerich  G. Melles     

Abstract Details

Purpose:

To describe a new surgical technique for flattening the corneal curvature and potentially reducing progression in eyes with advanced progressive keratoconus by using Bowman layer onlay grafting; and to show the preliminary outcomes of the first 5 patients undergoing this procedure.

Setting:

Retrospective, interventional case series conducted at the 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. At termination of the surgery, 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, 1 month, 2, 3 and 6 months postoperatively.

Results:

All surgeries could be performed successfully. A flattening of the corneal curvature was observed immediately after surgery. Average Kmax decreased from 74.9D (preoperative) to 69.1D at the latest postoperative tomography (1-6 months, median=2 months). All eyes showed a completely epithelialized and well-integrated graft. At 6 months, BSCVA had improved by 5 lines in case 1, who had preoperative central scarring. For cases 2 and 3, BSCVA (available at 2 and 3 months), remained unchanged. BCLVA at 6 months improved by 2 lines in case 1. Satisfaction was high and all eyes again had full contact lens tolerance.

Conclusions:

Bowman layer onlay grafting was found to provide about -6D of corneal flattening on average in all 5 eyes with progressive keratoconus.

Financial Disclosure:

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