title: Midstromal isolated Bowman layer graft for reduction of advanced keratoconus: a technique to postpone penetrating or deep anterior lamellar keratoplasty.
abstract: Midstromal implant of an isolated Bowman layer graft is a new approach to reduce ectasia in eyes with advanced keratoconus. The procedure should postpone penetrating or deep anterior lamellar keratoplasty. Ten eyes of 9 patients with progressive, advanced keratoconus and contact lens intolerance underwent the procedure with no intraoperative adverse events. Throughout the study period, we observed no complications related to stromal dissection and/or the Bowman layer graft. Maximum corneal power decreased from a mean (SD) of 74.5 (7.1) diopters (D) before to 68.3 (5.6) D after surgery (P = .002). Hence, implant of an isolated Bowman layer graft may offer a safe and effective new technique to reduce ectasia in eyes with advanced keratoconus, potentially allowing continued long-term contact lens wear. The low risk of complications may render the procedure suitable as a treatment to postpone penetrating or deep anterior lamellar keratoplasty in cases with impending contact lens intolerance and/or corneal scarring (clinicaltrials.gov Identifier: NCT01686906).
authors.affiliation: Netherlands Institute for Innovative Ocular Surgery, Rotterdam, the Netherlands2Melles Cornea Clinic Rotterdam, Rotterdam, the Netherlands.
authors.forename: Korine
authors.initials: K
authors.lastname: van Dijk
authors.affiliation: Netherlands Institute for Innovative Ocular Surgery, Rotterdam, the Netherlands2Melles Cornea Clinic Rotterdam, Rotterdam, the Netherlands3UAB Callahan Eye Hospital, Birmingham, Alabama.
authors.forename: Jack
authors.initials: J
authors.lastname: Parker
authors.affiliation: Netherlands Institute for Innovative Ocular Surgery, Rotterdam, the Netherlands4Amnitrans EyeBank Rotterdam, Rotterdam, the Netherlands.
authors.forename: C Maya
authors.initials: CM
authors.lastname: Tong
authors.affiliation: Netherlands Institute for Innovative Ocular Surgery, Rotterdam, the Netherlands2Melles Cornea Clinic Rotterdam, Rotterdam, the Netherlands4Amnitrans EyeBank Rotterdam, Rotterdam, the Netherlands.
authors.forename: Lisanne
authors.initials: L
authors.lastname: Ham
authors.affiliation: Netherlands Institute for Innovative Ocular Surgery, Rotterdam, the Netherlands4Amnitrans EyeBank Rotterdam, Rotterdam, the Netherlands.
authors.forename: Jessica T
authors.initials: JT
authors.lastname: Lie
authors.affiliation: Netherlands Institute for Innovative Ocular Surgery, Rotterdam, the Netherlands4Amnitrans EyeBank Rotterdam, Rotterdam, the Netherlands.
authors.forename: Esther A
authors.initials: EA
authors.lastname: Groeneveld-van Beek
authors.affiliation: Netherlands Institute for Innovative Ocular Surgery, Rotterdam, the Netherlands2Melles Cornea Clinic Rotterdam, Rotterdam, the Netherlands4Amnitrans EyeBank Rotterdam, Rotterdam, the Netherlands.
authors.forename: Gerrit R J
authors.initials: GR
authors.lastname: Melles
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D050541:Bowman Membrane / Q000601:surgery*; D063171:Corneal Pachymetry; D003319:Corneal Stroma / Q000601:surgery*; D019781:Corneal Topography; D016039:Corneal Transplantation; D005260:Female; D006801:Humans; D007640:Keratoconus / Q000175:diagnosis / Q000601:surgery*; D015948:Keratoplasty, Penetrating; D008297:Male; D012029:Refraction, Ocular / Q000502:physiology; D013524:Surgical Flaps; D014019:Tissue Donors; D016378:Tissue Transplantation; D041623:Tomography, Optical Coherence; D014792:Visual Acuity / Q000502:physiology; D055815:Young Adult