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Bowman's layer implantation to reduce and stabilize advanced progressive keratoconus

Poster Details

First Author: K.Van Dijk THE NETHERLANDS

Co Author(s):    V. Liarakos   J. Parker   L. Ham   J. Lie   E. Groeneveld-van Beek   G. Melles

Abstract Details


To evaluate the efficacy of Bowman layer (BL) implantation in reducing and stabilizing corneal ectasia (Kmax>69 Diopters (D)) in eyes with progressive advanced keratoconus (KC).


Netherlands Institute for Innovative Ocular Surgery / Tertiary referral center


Twenty-two eyes of nineteen patients with progressive 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), Pentacam measurements, endothelial cell density (ECD), biomicroscopy, and complications were evaluated at 1, 3, 6, 9 and 12 months postoperatively and every 6 months thereafter.


Surgeries were uneventful, except for two with an intra-operative perforation of Descemet membrane. No postoperative complications related to stromal dissection and/or isolated BL implantation were observed. Maximum corneal power decreased on average from 72.7 (±6.4) D preoperatively to 67.2 (±5.2) D (P=0.001) at 6 months after implantation and showed stable thereafter (P=0.335). Mean BSCVA improved from before to 12 months after BL implantation (P<0.001) and remained stable after that (P=0.357), while BCLVA did not change on average (P=0.105). Mean pachymetry measurements increased significantly from before to after the BL implantation (P<0.012). No change was observed in ECD from baseline to 12 months postoperative (P= 0.175) or thereafter (P=0.355).


BL implantation may be a safe and effective procedure to reduce and stabilize ectasia in eyes with advanced KC. Given the low risk for complications, the procedure may be suitable as a treatment to postpone penetrating or deep anterior lamellar keratoplasty. FINANCIAL INTEREST: One of more of the authors... receives consulting fees, retainer, or contract payments from a competing company

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