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    Bowman layer transplantation effective in advanced keratoconus


    For the current study, the researchers operated on 22 eyes in 19 patients with progressive, advanced keratoconus.

    Ten of the patients were male and nine were female, ranging in ages from 17 to 72 years, with keratoconus stages III to IV.

    Related: Thinking of keratoconus as refractive surgery

    At baseline, their eyes had a Kmax of more than 67.5 D and a best spectacle-corrected visual acuity (BSCVA) of worse than 20/60.

    All the eyes had documented evidence of keratoconus progression, defined as ≥1 D change in simulated keratometery (SimK) values, ≥ 2 D change in Kmax, or both, and a history of subjective decline in visual acuity.

    The surgeons removed the Bowman layers from donor corneas and created mid-stromal pockets up to the limbus over 360° under air using manual dissection. This procedure was similar to the procedure used to create a lamellar dissection plane in DALK, except that the dissection went to the mid-stroma.

    The surgeons inserted the donor Bowman layer into the stromal pocket, then unfolded and centered it using a cannula and balanced salt solutions to manipulate the tissue.

    Related: DALK explored as early approach to refractory acanthamoeba keratitis

    The procedure is less invasive than PK or DALK “because you are doing no cutting or sewing,” Dr. Parker said.

    Although it is technically feasible to place a donor Bowman layer in its true anatomic position in a keratoconic cornea, it cannot be fixated with currently available sutures or glues, making it difficult to obtain sufficient traction force across the cornea to flatten the central cone.

    As the corneas healed, the donor Bowman layers attached to the patients' corneas, and the incisions closed without sutures.

    “We’re not really sure why it works,” said Dr. Parker. “It seems to provoke a healing response in the cornea.”

    Complications, results

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