gms | German Medical Science

Purpose: To evaluate the 5-year clinical results of Bowman layer transplantation, a surgical technique to reduce and stabilize ectasia in eyes with advanced keratoconus.

Method: In twenty-two eyes of 19 patients undergoing Bowman layer transplantation for progressive, advanced keratoconus, corrected distance visual acuity (CDVA) with spectacles and contact lenses, Scheimpflug-based corneal tomography measurements, endothelial cell density, biomicroscopy, and postoperative complications were evaluated up to 60 months after surgery.

Result: Mean maximum keratometry decreased on average from 77.2 (±6.2) D to 69.2 (±3.7) D at one month postoperatively (P<.05), and remained stable thereafter (P>.05). Mean LogMar spectacle CDVA improved from 1.27 (±0.44) before to 0.90 (±0.30) 12 months postoperatively (P<.05), with stabilization thereafter (P>.05). During the whole follow-up period, no change in mean contact lens CDVA was observed (P>.05). Pachymetry increased from before to one month postoperatively (P<.05), after which no changes were found (P>.05). One eye experienced a corneal hydrops 4.5 years postoperatively; no other postoperative complications were observed Endothelial cell density remained stable from pre- to postoperatively (P>.05).

Conclusion: With isolated Bowman layer transplantation, reduction of corneal ectasia and stabilization up to five years thereafter was achieved in eyes with progressive, advanced keratoconus. The procedure may be performed to postpone penetrating or deep anterior lamellar keratoplasty.