Bowman’S Layer Transplantation As A Therapeutic Strategy For Advanced Neurotrophic Keratopathy

To evaluate the role of Bowman’s layer transplantation in stabilizing the ocular surface in eyes with advanced neurotrophic keratopathy at imminent risk of corneal perforation.

This study included four eyes with neurotrophic corneal ulcers treated at the Department of Diagnostics and Microsurgery of Glaucoma, Medical University of Lublin, Poland.

This descriptive case series included four eyes with severe neurotrophic keratopathy threatening corneal perforation that underwent Bowman’s layer transplantation after failure of conventional medical therapy. The following parameters were assessed: best-corrected visual acuity (BCVA), corneal epithelial healing, changes in corneal thickness measured by anterior segment optical coherence tomography (AS-OCT), and the need for additional surgical interventions.

Results

In all four eyes, Bowman’s layer transplantation provided effective structural reinforcement of the anterior cornea. The acellular, collagen-rich Bowman’s layer acted as a protective scaffold, promoting epithelial stabilization and reducing stromal exposure. The procedure prevented imminent corneal perforation in all cases and contributed to the resolution of persistent epithelial defects. Although corneal innervation was not restored, corneal integrity was maintained, and the need for emergency penetrating keratoplasty was avoided throughout the follow-up period.

Bowman’s layer transplantation appears to be a valuable surgical option for eyes with advanced neurotrophic keratopathy at high risk of perforation. By enhancing corneal biomechanical stability and supporting epithelial healing, this technique may serve as an effective globe-preserving intervention in carefully selected cases. Larger studies are warranted to confirm these findings and to better define long-term outcomes and indications.