ESCRS - FPS02.05 - Bowman Layer Onlay Grafting As A Minimally Invasive Technique To Flatten The Corneal Curvature And Reduce Progression In Eyes With Ectasia And Advanced Keratoconus

Bowman Layer Onlay Grafting As A Minimally Invasive Technique To Flatten The Corneal Curvature And Reduce Progression In Eyes With Ectasia And Advanced Keratoconus

Published 2022 - 40th Congress of the ESCRS

Reference: FPS02.05 | Type: Free paper

Authors: Lydia Catharina Van Der Star* 1 , Viridiana Kocaba 2 , Isabel Dapena 3 , Esther Groeneveld-van Beek 4 , Korine van Dijk 1 , Silke Oellerich 5 , Gerrit Melles 4

1Netherlands Institute for Innovative Ocular Surgery (NIIOS),Rotterdam,Netherlands;Melles Cornea Clinic,Rotterdam,Netherlands, 2Netherlands Institute for Innovative Ocular Surgery (NIIOS),Rotterdam,Netherlands;Melles Cornea Clinic,Rotterdam,Netherlands;Tissue and Cell Therapy Group, Singapore Eye Research Institute ,Singapore,Singapore, 3Netherlands Institute for Innovative Ocular Surgery (NIIOS),Rotterdam,Netherlands;Melles Cornea clinic,Rotterdam,Netherlands, 4Netherlands Institute for Innovative Ocular Surgery (NIIOS),Rotterdam,Netherlands;Amnitrans EyeBank ,Rotterdam,Netherlands, 5Netherlands Institute for Innovative Ocular Surgery (NIIOS),Rotterdam,Netherlands

Purpose

To describe the clinical outcomes of Bowman layer (BL) onlay grafting for flattening the corneal curvature and reducing progression in eyes with advanced progressive keratoconus.

Setting

Prospective, interventional case series conducted at the Netherlands Institute for Innovative Ocular Surgery.

Methods

Twenty-one eyes with advanced progressive keratoconus underwent BL-onlay grafting. The surgical technique consisted of removing the corneal epithelium, placing and “stretching” a single or double BL-graft onto the stroma. The BL-transplant was then allowed to dry-in and left to attach to the recipient cornea and a soft bandage lens was placed on the eye. Best spectacle- and/or best contact lens-corrected visual acuity (BSCVA/BCLVA), corneal tomography, and complications were recorded. Follow-up ranged from 1-24 months with a mean follow-up time of 15±8 months.

Results

All twenty-one surgeries could be performed without intraoperative complications. Average maximum keratometry changed from 77±13 D preoperatively to 72±10 D at 1-24 months postoperatively (n=21, P<0.05). BSCVA improved at least one Snellen line in 16/21 (76%) of the cases, changing on average from preoperatively 0.8±0.4 to 0.4±0.3 LogMAR postoperatively (P<0.05) and mean BCLVA remained stable. Two eyes required a re-positioning of the BL-graft, 4 eyes underwent a re-BL-transplantation because of uncompleted re-epithelialisation. All eyes showed a completely re-epithelialized and well-integrated graft at the last available follow-up.

Conclusions

BL-onlay grafting may be a feasible surgical technique, providing on average -5D of corneal flattening in eyes with advanced progressive keratoconus, while preserving patient’s vision.