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Epithelium, Bowman's and cross-linking : a pilot study

Poster Details

First Author: T.Sj INDIA

Co Author(s):    D. Shetty   D. Nagaraj   D. Pahuja              

Abstract Details


To study the epithelium and bowmans using epithelial profile map and to compare the efficacy and safety of Epi-Bowman Keratectomy (EBK) using Epiclear™ epikeratome with a mechanical scrapper for corneal epithelium debridement during corneal collagen cross-linking (CXL).


Narayana Nethralaya, Super speciality Eye hospital and post graduate institute of ophthalomology, Bangalore, India.


100 eyes of 100 patients undergoing CXL were included in this study. In this group, 50 eyes of 50 patients underwent EBK and the other 50 eyes with a mechanical scrapper to remove the epithelium. Intra-operative spectral domain optical coherence tomography (SD OCT; Bioptigen Inc, Durham, NC) was performed to evaluate the integrity of the Bowman’s membrane following epithelial removal. The time taken for epithelial removal, post-operative pain score using the Wong-Baker’s pain scale, time for epithelial healing and the epithelial profile using the Optovue(Inc. Fremont, CA) during the healing was observed and analyzed between the 2 groups.


Intra-operative SD OCT showed a smooth and undamaged Bowman’s membrane when EBK was performed.15 eyes with mechanical scraper showed a break in the bowmans. Post-operative pain was significantly less (p <0.001 in CXL group) with faster epithelial healing (p < 0.0001 in CXL group) in the EBK subgroup as compared to the mechanical scrapper subgroup. Epithelial profiling during the healing phase showed an edematous epithelium in the initial 2 weeks in the mechanical scrapper subgroup while the EBK subgroup showed minimal epithelial edema lasting up to a week with regularized and smooth corneal epithelium healing. Outcomes of crosslinking were studied using biomarkers for collage 1 and 4 and lysyl oxidase,in which a strong correlation was found.


EBK appears to be an effective and safe method of corneal epithelial debridement with negligible damage to the Bowman’s membrane and the surrounding epithelium leading to early healing thereby reducing the post-operative pain and complications. Study of bowmans and epithelium may help in understanding the pathology of Keratoconus. The removal of epithelium in cross linking by EBK may play a important role in better outcomes of cross linking.

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