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).
Bibliographical noteFunding 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.
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- Bowman layer
- corneal transplantation
- deep anterior lamellar keratoplasty
- progressive ectasia
- surgical technique