Bowman layer onlay grafting as a minimally invasive treatment for the most challenging cases in keratoconus

Lydia van der Star, Indrė Vasiliauskaitė, Silke Oellerich, Esther A Groeneveld-van Beek, Mohamed Ghaly, Achraf Laouani, Keamela Vasanthananthan, Korine van Dijk, Isabel Dapena, Gerrit R J Melles, Viridiana Kocaba

Onderzoeksoutput: Articlepeer review


Purpose: To analyze the clinical outcomes after Bowman layer (BL) onlay grafting for the treatment of progressive, advanced keratoconus. Design: Prospective, interventional case series. Methods: Twenty-one eyes underwent BL onlay grafting. After removing the epithelium, a single or double BL graft was “stretched” onto the corneal surface, allowed to dry-in, and a soft bandage lens was placed until the graft was re-epithelialized. Best spectacle- and/or best contact lens–corrected visual acuity (BSCVA/BCLVA), corneal tomography, and postoperative complication rates were analyzed for the total group and 2 subgroups (group 1: preoperative maximum keratometry [Kmax] <69 diopters [D; n = 7); group 2: preoperative Kmax ≥69 D [n = 14]). Follow-up ranged from 6 to 36 months (mean 21 ± 11 months). Results: All 21 surgeries were uneventful. Overall, Kmax changed from 76 ± 12 D preoperatively to 72 ± 9 D at 6 to 36 months postoperatively (P = .015). Kmax decreased by 6 D in group 2 (P = .002) but did not change in group 1. Average BSCVA remained stable for group 1 and improved from preoperatively 0.8 ± 0.4 to 0.4 ± 0.2 logarithm of the minimum angle of resolution postoperatively in group 2 (P = .032); BCLVA remained stable (P > .05). Within the first postoperative weeks, 2 eyes required BL graft repositioning after inadvertent bandage lens removal and 4 eyes underwent BL retransplantation for incomplete re-epithelialization. One eye underwent BL regrafting 12 months postoperatively after traumatic corneal erosion. All eyes showed a completely re-epithelialized graft at the last available follow-up. Conclusions: BL onlay grafting is a completely extraocular, minimally invasive surgical technique, providing up to −6 D of corneal flattening in eyes with advanced progressive keratoconus, allowing for continued (scleral) contact lens wear and therefore preserving the BCLVA.

Originele taal-2English
Pagina's (van-tot)54-65
Aantal pagina's12
TijdschriftAmerican Journal of Ophthalmology
StatusPublished - mei 2024

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