New keratoconus treatment - Bowman layer transplantation - A State of Sight #88

The Melles CorneaClinic Rotterdam at the Netherlands Institute for Innovate Ocular Surgery recently published their findings for a potential breakthrough treatment for advanced keratoconus. Watch this episode of A State of Sight with Isaac Porter, MD to learn more about selective Bowman layer transplantation.

With this treatment, patients with keratoconus were able to use contact lenses after surgery and improve their vision. At this stage of keratoconus, the other primary options to restore vision are full thickness (penetrating keratoplasty) and partial thickness (deep anterior lamellar keratoplasty). With this innovative treatment, patients may be able to keep their own cornea longer and delay the need for larger transplants.

Welcome to A State of Sight, I’m Isaac Porter and this is your update in ophthalmology and eye care. In this episode, I would like to explain a new technique that was just published, a selective transplant of the Bowman layer in patients with severe keratoconus.
This is extremely innovative from the Melles CorneaClinic Rotterdam including Korine van Dijk, who published these findings. A Bowman layer (the second layer of the cornea after the epithelium), was transplanted into the middle of these patients’ corneas with advanced keratoconus.
All of these patients could not wear contact lenses, including scleral contact lenses which can help some people with keratoconus. Instead of resting on the cornea, these special contact lenses can rest on the white part of the eye (the sclera) and vault over the cornea.
These patients had very steep corneas. Since they couldn’t wear contact lenses, they were likely going to need a corneal transplant to restore their vision if this procedure was not available.
The results were very successful and all of the patients were able to wear contact lenses afterwards. It also showed that their corneas, instead of being so steep, flattened some which was probably the key in getting them back into the contact lenses.
This will be used more and we expect to hear more about this new type of transplant in the future.
These surgeons placed the Bowman layer into alcohol to remove any living cells to reduce the risk for rejection.Then the Bowman layer was placed midway in the cornea into a pocket they created.
This idea is very innovative, because with advanced keratoconus we see breaks in the Bowman layer. The group thought that supplementing the cornea with a good, strong layer they could flatten the cornea and also help prevent any further progression or steepening of the keratoconus.

I know this is a great new technique and if you have any questions about it, please post them below. We will be happy to answer your questions, and we hope to see you again soon on A State of Sight.