gms | German Medical Science

Purpose: To evaluate the efficacy of Bowman layer (BL) transplantation in reducing and stabilizing corneal ectasia in eyes with progressive advanced keratoconus (KC).

Methods: Twenty-two eyes of nineteen patients with progressive advanced KC, not eligible for UV-crosslinking, underwent mid-stromal implantation of an isolated BL and were followed for a mean of 21 (±7) months. Best spectacle corrected visual acuity (BSCVA), Best contact lens corrected visual acuity (BCLVA), Scheimpflug measurements, endothelial cell density (ECD), biomicroscopy, and complications were evaluated at 1, 3, 6, 9 and 12 months postoperatively and every 6 months thereafter.

Results: Surgeries were uneventful, except for two with an intra-operative perforation of Descemet membrane; no postoperative complications were observed. Maximum keratometry decreased from 77.8 (±6.2) D before to 70.3 (±4.5) D (P<.001) at 6 months after surgery and showed stable thereafter (P=0.298). Mean BSCVA improved from before to 12 months after BL transplantation (P<.001), while BCLVA did not change on average (P=.105). Mean pachymetry increased (P<.012), and no change in ECD was found (P=.355).

Conclusions: BL transplantation may be safe and effective in halting the progression of ectasia in eyes with advanced keratoconus, and may therefore reduce or delay the need for penetrating or anterior lamellar keratoplasty and their associated complications.