ESCRS - PO313 - Femtosecond Laser Assisted Bowman Layer Implantation Combined With Corneal Crosslinking (Fbi Xtra) For Advanced Progressive Keratoconus: 5 Years Follow Up

Femtosecond Laser Assisted Bowman Layer Implantation Combined With Corneal Crosslinking (Fbi Xtra) For Advanced Progressive Keratoconus: 5 Years Follow Up

Published 2022 - 40th Congress of the ESCRS

Reference: PO313 | Type: Free paper | DOI: 10.82333/g6ny-c446

Authors: Vivian Paraskevi Douglas* 1 , Konstantinos A.A Douglas 2 , Vasilis S. Liarakos 3

1Ophthalmology,Naval and Veterans Hospital,Athens,Greece;Ophthalmology,Aktina center,Athens,Greece, 2Ophthalmology,Aktina center,Athens,Greece;Ophthalmology,National and Kapodistrian University of Athens, "G. Gennimatas" General Hospital, Athens, Greece,Athens,Greece, 3Ophthalmology,Aktina center,Athens,Greece;Ophthalmology,Naval and Veterans Hospital,Athens,Greece

Purpose

To evaluate long-term survival and efficiency of a novel surgical treatment (Femtosecond Laser Assisted Bowman Layer Implantation Combined With Corneal Crosslinking - FBI Xtra) for advanced progressive keratoconus. 

Setting

Athens Naval Hospital, AKTINA Center

Methods

A 21-year-old Caucasian male with advanced progressive keratoconus, intolerant to contact lenses and reluctant for DALK, with a maximum corneal curvature of 92.0D and thinnest corneal thickness of 147 microns, underwent FBI Xtra. An intrastromal dissection at a precise depth was created with a Femtosecond Laser device and a donor Bowman layer was implanted using a modified manipulator. Riboflavin 0.1% was irrigated inside the pocket followed by ultraviolet (UV-A) irradiation (370nm; 3mW/cm2 ). No sutures were used. The patient was followed for 5 years with Anterior Segment Spectral Domain Optical Coherence Tomography, Corneal Topography and Ray tracing Aberrometry. 

Results

The dissection plane was uniform and smooth, at an equal depth. Direct intrastromal irrigation with riboflavin increased corneal thickness over 400 microns, allowing for UV crosslinking. The patient was able to return to his routine the next day with minor discomfort. Corneal thickness increased symmetrically by an average of 50 microns. Mean curvature was reduced from 70.0D to 66.5D within the first month. Epithelial map was normalized, allowing for contact lens fitting. The cornea remained transparent and stable 5 years after surgery without any complication. No rejection or opacification of the graft was noticed over the 5 years of follow up. Corneal pachymetry map and corneal topography remained stable over the follow up period. 

Conclusions

Femto Bowman Implantation combined with Crosslinking (FBI Xtra) is a safe novel procedure that may achieve precise, uniform and predictable intrastromal implantation of a donor Bowman layer combined with securing the result with UV crosslinking. Results remain stable over 5 years.