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    Bowman layer transplantation effective in advanced keratoconus


    “The problem with patients who have keratoconus is that the cornea is changing shape,” said Dr. Parker. “A lot of times you can help them with contact lenses, but if the cornea is getting worse they’ll outgrow their lenses.”

    Recent: Why single-instrument screening for keratoconus remains a dream

    At that point, penetrating keratoplasty (PK) or deep anterior lamellar keratoplasty (DALK) may restore some vision, but these procedures come with the risk for infection and other complications, may not halt the progress of the disease, and can make the cornea vulnerable to injury, said Dr. Parker.

    More recently, surgeons have used ultraviolet A radiation to induce collagen cross-linking in patients with mild to moderate keratoconus. This procedure can halt the progression of the disease, but patients with advanced keratoconus are not eligible for the treatment, Dr. Parker said. He and colleagues are proposing Bowman layer grafts as an alternative.

    A smooth, acellular, nonregenerating membrane composed of collagen fibrils, the Bowman layer lies between the superficial epithelium and the stroma in the cornea. Because it has no cells, the layer does not provoke a graft rejection when transplanted, Dr. Parker said.

    Related: Optimizing cataract outcomes when keratoconus is present

    Coauthor Gerrit R.J. Melles, MD, PhD, came up with the idea of transplanting it into eyes with keratoconus, Dr. Parker said. Dr. Melles, an ophthalmologist at the Netherlands Institute for Innovative Ocular Surgery in Rotterdam, has a reputation for pioneering new cornea surgeries.

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