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Dapena I, van der Star L, Groeneveld-van Beek EA, et al. Bowman Layer Onlay Grafting: Proof-of-Concept of a New Technique to Flatten Corneal Curvature and Reduce Progression in Keratoconus. Cornea. 2021;40(12):1561-1566doi: 10.1097/ICO.0000000000002740.
Dapena, I., van der Star, L., Groeneveld-van Beek, E. A., Quilendrino, R., van Dijk, K., Parker, J. S., Oellerich, S., & Melles, G. R. J. (2021). Bowman Layer Onlay Grafting: Proof-of-Concept of a New Technique to Flatten Corneal Curvature and Reduce Progression in Keratoconus. Cornea, 40(12), 1561-1566. https://doi.org/10.1097/ICO.0000000000002740
Dapena, Isabel, et al. "Bowman Layer Onlay Grafting: Proof-of-Concept of a New Technique to Flatten Corneal Curvature and Reduce Progression in Keratoconus." Cornea vol. 40,12 (2021): 1561-1566. doi: https://doi.org/10.1097/ICO.0000000000002740
Dapena I, van der Star L, Groeneveld-van Beek EA, Quilendrino R, van Dijk K, Parker JS, Oellerich S, Melles GRJ. Bowman Layer Onlay Grafting: Proof-of-Concept of a New Technique to Flatten Corneal Curvature and Reduce Progression in Keratoconus. Cornea. 2021 Dec 01;40(12):1561-1566. doi: 10.1097/ICO.0000000000002740. PMID: 33859087.
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Cornea. 2021 Dec 01;40(12):1561-1566. doi: 10.1097/ICO.0000000000002740.

Bowman Layer Onlay Grafting: Proof-of-Concept of a New Technique to Flatten Corneal Curvature and Reduce Progression in Keratoconus.

Cornea

Isabel Dapena, Lydia van der Star, Esther A Groeneveld-van Beek, Ruth Quilendrino, Korine van Dijk, Jack S Parker, Silke Oellerich, Gerrit R J Melles

Affiliations

  1. Netherlands Institute for Innovative Ocular Surgery, Rotterdam, the Netherlands.
  2. Melles Cornea Clinic Rotterdam, the Netherlands.
  3. Amnitrans EyeBank Rotterdam, the Netherlands.
  4. UAB, Birmingham, AL; and.
  5. NIIOS-USA, San Diego, CA.

PMID: 33859087 DOI: 10.1097/ICO.0000000000002740

Abstract

PURPOSE: 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.

METHODS: 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.

RESULTS: 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.

CONCLUSIONS: BL onlay grafting may be a feasible surgical technique, providing up to -5 D of corneal flattening in eyes with advanced KC.

Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

Conflict of interest statement

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

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