Bowman layer transplantation in the treatment of keratoconus

Diana C. Dragnea, Rénuka S. Birbal, Lisanne Ham, Isabel Dapena, Silke Oellerich, Korine van Dijk, Gerrit R.J. Melles

Research output: Contribution to journalScientific reviewpeer-review

28 Citations (Scopus)


Several treatment options corresponding to the grade of keratoconus have been established. These are ultra-violet corneal crosslinking and intracorneal ring segments for mild to moderate keratoconus, and penetrating keratoplasty or deep anterior lamellar keratoplasty for the more advanced cases of keratoconus. Bowman layer transplantation was developed as a procedure for patients with advanced, progressive keratoconus. The technique consists of transplanting an isolated donor Bowman layer into a mid-stromal pocket of a keratoconic cornea resulting in corneal flattening and stabilization against further ectasia. Thus, it aims at corneal stabilization in eyes with advanced keratoconus, and enabling continued contact lens wear for normal visual functionality. By being a sutureless procedure and using an acellular graft, it potentially avoids commonly known suture and graft-related complications of penetrating or deep anterior lamellar keratoplasty. The treatment seems to be a promising option in the management of advanced keratoconus in order to postpone or prevent a more invasive corneal surgery, while minimizing the risk of complications and allowing less stringent surveillance and less intensive medical therapy.

Original languageEnglish
Article number24
JournalEye and Vision
Issue number1
Publication statusPublished - Dec 2018

Bibliographical note

Funding Information:
Dr. Melles is a consultant for DORC International and SurgiCube International. Dr. Dapena is a consultant for DORC International. No other author has a financial or proprietary interest in any material or method mentioned.

Publisher Copyright:
© 2018, The Author(s).


  • Advanced keratoconus
  • Bowman layer
  • Cornea
  • Crosslinking
  • Deep anterior lamellar keratoplasty
  • Intracorneal ring segments
  • Penetrating keratoplasty


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