Long-Term Outcomes of Bowman Layer Inlay Transplantation for the Treatment of Progressive Keratoconus

Lydia Van Der Star; Korine Van Dijk; Indrė Vasiliauskaitė; Isabel Dapena; Silke Oellerich; Gerrit R.J. Melles

doi:10.1097/ICO.0000000000002871

Long-Term Outcomes of Bowman Layer Inlay Transplantation for the Treatment of Progressive Keratoconus

Lydia Van Der Star, Korine Van Dijk, Indrė Vasiliauskaitė, Isabel Dapena, Silke Oellerich, Gerrit R.J. Melles

Ophthalmology - Eye surgery

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Abstract

Purpose:To report long-term clinical outcomes and estimated success rates after Bowman layer (BL) inlay transplantation in eyes treated for progressive keratoconus (KC).Methods:Thirty-five eyes (29 patients) with progressive KC underwent BL inlay transplantation. Best-corrected spectacle and contact lens visual acuity, Scheimpflug-based corneal tomography [simulated and maximum keratometry (Kmax)], central corneal thickness, thinnest point thickness, complications, and success rate were evaluated up to 8 years postoperatively for the total group and 2 subgroups [group 1: preoperative Kmax > 69 diopter (D) (n = 26); group 2: preoperative Kmax < 69D (n = 9)].Results:Mean logarithm of the minimum angle of resolution best contact lens-corrected visual acuity for the total group and the 2 subgroups did not change from preoperative up to the last available follow-up (all P > 0.05), whereas best spectacle-corrected visual acuity improved for group 1 (P = 0.03). Group 1 showed an average Kmax reduction of 7D in the first month (P < 0.001) with no further changes up to 8 years postoperatively (P > 0.05), whereas no significant changes were observed in group 2 (all P > 0.05). Postoperative KC progression occurred in 4 eyes (n = 3 group 1, n = 1 group 2) and 1 eye (group 2) underwent retransplantation for unsatisfactory visual performance. Kaplan-Meier analysis showed an estimated success rate of 85% at the 5 to 8 years follow-up in group 1 and of 75% at the 5 to 7 years follow-up for group 2.Conclusions:BL inlay transplantation stabilized KC in most eyes along with preservation of contact lens tolerance up to 8 years postoperatively and may be a successful treatment option, in particular for eyes with progressive advanced KC (Kmax > 69D).

Original language	English
Pages (from-to)	1150-1157
Number of pages	8
Journal	Cornea
Volume	41
Issue number	9
DOIs	https://doi.org/10.1097/ICO.0000000000002871
Publication status	Published - 1 Sep 2022

Bibliographical note

Funding Information:
Underlying research reported in this study was partly funded by the “Rotterdamse Stichting Blindenbelangen,” the “Landelijke Stichting voor Blinden en Slechtzienden,” the “Oogfonds,” and the “Algemene Nederlandse Vereniging ter Voorkoming van Blindheid.” The funding organizations had no role in the design or conduct of this research. They provided unrestricted grants.

Publisher Copyright:
© 2022 Lippincott Williams and Wilkins. All rights reserved.

Keywords

Bowman layer
corneal transplantation
deep anterior lamellar keratoplasty
keratoconus
progressive ectasia
surgical technique

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10.1097/ICO.0000000000002871

Author manuscript Long-term BL InlayAccepted author manuscript, 2.01 MB

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title = "Long-Term Outcomes of Bowman Layer Inlay Transplantation for the Treatment of Progressive Keratoconus",

abstract = "Purpose:To report long-term clinical outcomes and estimated success rates after Bowman layer (BL) inlay transplantation in eyes treated for progressive keratoconus (KC).Methods:Thirty-five eyes (29 patients) with progressive KC underwent BL inlay transplantation. Best-corrected spectacle and contact lens visual acuity, Scheimpflug-based corneal tomography [simulated and maximum keratometry (Kmax)], central corneal thickness, thinnest point thickness, complications, and success rate were evaluated up to 8 years postoperatively for the total group and 2 subgroups [group 1: preoperative Kmax > 69 diopter (D) (n = 26); group 2: preoperative Kmax < 69D (n = 9)].Results:Mean logarithm of the minimum angle of resolution best contact lens-corrected visual acuity for the total group and the 2 subgroups did not change from preoperative up to the last available follow-up (all P > 0.05), whereas best spectacle-corrected visual acuity improved for group 1 (P = 0.03). Group 1 showed an average Kmax reduction of 7D in the first month (P < 0.001) with no further changes up to 8 years postoperatively (P > 0.05), whereas no significant changes were observed in group 2 (all P > 0.05). Postoperative KC progression occurred in 4 eyes (n = 3 group 1, n = 1 group 2) and 1 eye (group 2) underwent retransplantation for unsatisfactory visual performance. Kaplan-Meier analysis showed an estimated success rate of 85% at the 5 to 8 years follow-up in group 1 and of 75% at the 5 to 7 years follow-up for group 2.Conclusions:BL inlay transplantation stabilized KC in most eyes along with preservation of contact lens tolerance up to 8 years postoperatively and may be a successful treatment option, in particular for eyes with progressive advanced KC (Kmax > 69D).",

keywords = "Bowman layer, corneal transplantation, deep anterior lamellar keratoplasty, keratoconus, progressive ectasia, surgical technique",

author = "{Van Der Star}, Lydia and {Van Dijk}, Korine and Indrė Vasiliauskaitė and Isabel Dapena and Silke Oellerich and Melles, {Gerrit R.J.}",

note = "Funding Information: Underlying research reported in this study was partly funded by the “Rotterdamse Stichting Blindenbelangen,” the “Landelijke Stichting voor Blinden en Slechtzienden,” the “Oogfonds,” and the “Algemene Nederlandse Vereniging ter Voorkoming van Blindheid.” The funding organizations had no role in the design or conduct of this research. They provided unrestricted grants. Publisher Copyright: {\textcopyright} 2022 Lippincott Williams and Wilkins. All rights reserved.",

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doi = "10.1097/ICO.0000000000002871",

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T1 - Long-Term Outcomes of Bowman Layer Inlay Transplantation for the Treatment of Progressive Keratoconus

AU - Van Der Star, Lydia

AU - Van Dijk, Korine

AU - Vasiliauskaitė, Indrė

AU - Dapena, Isabel

AU - Oellerich, Silke

AU - Melles, Gerrit R.J.

N1 - Funding Information: Underlying research reported in this study was partly funded by the “Rotterdamse Stichting Blindenbelangen,” the “Landelijke Stichting voor Blinden en Slechtzienden,” the “Oogfonds,” and the “Algemene Nederlandse Vereniging ter Voorkoming van Blindheid.” The funding organizations had no role in the design or conduct of this research. They provided unrestricted grants. Publisher Copyright: © 2022 Lippincott Williams and Wilkins. All rights reserved.

PY - 2022/9/1

Y1 - 2022/9/1

N2 - Purpose:To report long-term clinical outcomes and estimated success rates after Bowman layer (BL) inlay transplantation in eyes treated for progressive keratoconus (KC).Methods:Thirty-five eyes (29 patients) with progressive KC underwent BL inlay transplantation. Best-corrected spectacle and contact lens visual acuity, Scheimpflug-based corneal tomography [simulated and maximum keratometry (Kmax)], central corneal thickness, thinnest point thickness, complications, and success rate were evaluated up to 8 years postoperatively for the total group and 2 subgroups [group 1: preoperative Kmax > 69 diopter (D) (n = 26); group 2: preoperative Kmax < 69D (n = 9)].Results:Mean logarithm of the minimum angle of resolution best contact lens-corrected visual acuity for the total group and the 2 subgroups did not change from preoperative up to the last available follow-up (all P > 0.05), whereas best spectacle-corrected visual acuity improved for group 1 (P = 0.03). Group 1 showed an average Kmax reduction of 7D in the first month (P < 0.001) with no further changes up to 8 years postoperatively (P > 0.05), whereas no significant changes were observed in group 2 (all P > 0.05). Postoperative KC progression occurred in 4 eyes (n = 3 group 1, n = 1 group 2) and 1 eye (group 2) underwent retransplantation for unsatisfactory visual performance. Kaplan-Meier analysis showed an estimated success rate of 85% at the 5 to 8 years follow-up in group 1 and of 75% at the 5 to 7 years follow-up for group 2.Conclusions:BL inlay transplantation stabilized KC in most eyes along with preservation of contact lens tolerance up to 8 years postoperatively and may be a successful treatment option, in particular for eyes with progressive advanced KC (Kmax > 69D).

AB - Purpose:To report long-term clinical outcomes and estimated success rates after Bowman layer (BL) inlay transplantation in eyes treated for progressive keratoconus (KC).Methods:Thirty-five eyes (29 patients) with progressive KC underwent BL inlay transplantation. Best-corrected spectacle and contact lens visual acuity, Scheimpflug-based corneal tomography [simulated and maximum keratometry (Kmax)], central corneal thickness, thinnest point thickness, complications, and success rate were evaluated up to 8 years postoperatively for the total group and 2 subgroups [group 1: preoperative Kmax > 69 diopter (D) (n = 26); group 2: preoperative Kmax < 69D (n = 9)].Results:Mean logarithm of the minimum angle of resolution best contact lens-corrected visual acuity for the total group and the 2 subgroups did not change from preoperative up to the last available follow-up (all P > 0.05), whereas best spectacle-corrected visual acuity improved for group 1 (P = 0.03). Group 1 showed an average Kmax reduction of 7D in the first month (P < 0.001) with no further changes up to 8 years postoperatively (P > 0.05), whereas no significant changes were observed in group 2 (all P > 0.05). Postoperative KC progression occurred in 4 eyes (n = 3 group 1, n = 1 group 2) and 1 eye (group 2) underwent retransplantation for unsatisfactory visual performance. Kaplan-Meier analysis showed an estimated success rate of 85% at the 5 to 8 years follow-up in group 1 and of 75% at the 5 to 7 years follow-up for group 2.Conclusions:BL inlay transplantation stabilized KC in most eyes along with preservation of contact lens tolerance up to 8 years postoperatively and may be a successful treatment option, in particular for eyes with progressive advanced KC (Kmax > 69D).

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KW - corneal transplantation

KW - deep anterior lamellar keratoplasty

KW - keratoconus

KW - progressive ectasia

KW - surgical technique

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Long-Term Outcomes of Bowman Layer Inlay Transplantation for the Treatment of Progressive Keratoconus

Abstract

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