Femtosecond-assisted Bowman's–stromal inlay using IOL injector as an option in keratoconus management

Session Details

Session Title: Keratoconus & Secondary Ectasia

Session Date/Time: Sunday 15/09/2019 | 08:00-10:00

Paper Time: 08:30

Venue: Free Paper Forum: Podium 2

First Author: : V.Mittal INDIA

Co Author(s): :    P. Narang   N. Sahdev   R. Mittal                       

Abstract Details

Purpose:

To demonstrate the surgical technique of femtosecond assisted transplant of Bowman membrane and anterior stroma called Bowman-Stromal Inlay (BS Inlay) using an IOL injector as an alternative to Bowman membrane transplant alone in Keratoconus and to report the early results in first 10 patients.

Setting:

LJ Eye Institute, Ambala, Haryana

Methods:

Prospective interventional case series. 10 consecutive patients underwent BS Inlay for progressive keratoconus. Femtosecond laser was used to prepare BS inlay from human donor cornea (7-8.5 mm diameter, 130-200 microns thick; after alcohol assisted epithelial removal; Lamellar keratoplasty module) and intra-stromal pocket (130 microns, 9.5mm diameter; modified LASIK flap making module- minimal side cuts energy and 3mm width of canal) in recipient keratoconus eye. Inlay was injected in the pocket using IOL injector system. The unfolding and desired centration was achieved by surface massage and manipulation using 26G cannula. Pre and Postoperative UCVA, BCVA, Topography and Pachymetry changes were noted.

Results:

Technique was successfully used to transplant BS inlay in 10 patients of keratoconus with 1-6 months follow-up. First patient had reverse orientation of BS inlay (BM facing endothelium), while rest 9 patients had desired orientation and centration. The technical ease of implanting & manipulation of BS inlay was appreciated in all. Postoperatively, interface was clear in all cases. Mean Pre-operative and post-operative corneal thickness was 385.66 microns (Range- 273-488) and 534 microns (Range- 485-561). Final post-operative UCVA and BCVA was similar or slightly better than pre-operative visual acuity. Tomography maps showed either minimal flattening or no changes from pre-operative maps.

Conclusions:

BS inlay using femtosecond laser and IOL injector makes other wise surgically difficult BM transplant easy. The additional stroma injected in thin keratoconus cornea may offer additional benefit. There was either no or slightly favorable findings of BCVA and tomography during limited follow-up of unto 6 months.

Financial Disclosure:

None