van Dijk Korine, Parker Jack S, Baydoun Lamis, Ilyas Abbas, Dapena Isabel, Groeneveld-van Beek Esther A, Melles Gerrit R J
Netherlands Institute for Innovative Ocular Surgery, Laan op Zuid 88, 3071 AA, Rotterdam, The Netherlands.
Melles Cornea Clinic Rotterdam, Rotterdam, The Netherlands.
Graefes Arch Clin Exp Ophthalmol. 2018 Jun;256(6):1151-1158. doi: 10.1007/s00417-018-3927-7. Epub 2018 Feb 14.
The purpose of this study was to evaluate the 5-year clinical results of isolated Bowman layer (BL) transplantation in the treatment of advanced keratoconus.
In this prospective, single-center, interventional case series at a tertiary referral center, 20 eyes of 17 patients with advanced keratoconus underwent BL transplantation, i.e. an isolated Bowman layer graft was positioned into a manually dissected mid-stromal pocket. Scheimpflug-based corneal tomography measurements, best corrected spectacle and contact lens visual acuities (BSCVA and BCLVA), endothelial cell density, and complications were evaluated up to 5 years after surgery.
Measured simulated and maximum keratometry (Kmean and Kmax) values were stable up to 5 years after surgery (P = .310 and P = .195 for 5 years compared to 1 month follow-up, respectively), following an initial decrease from pre- to 1 month postoperatively (P < .001 each). Mean LogMAR BSCVA remained stable (P > .99), after an initial improvement from pre- to 12 months postoperatively (P = .007). Mean BCLVA did not change from preoperative to 5 years postoperatively (P = .219). During all postoperative follow-ups, mean densitometry values were higher than preoperatively (P < .001). A corneal hydrops occurred in one eye at 4.5 years postoperatively; no other postoperative complications were observed. Kaplan-Meier analysis showed an estimated success rate of 84% at 5 years postoperatively. Endothelial cell density remained stable from before to 5 years after surgery (P = .319).
After early postoperative corneal flattening, topographies were stable up to 5 years after BL transplantation, preserving BCLVA and contact lens tolerance, potentially allowing long term postponement of penetrating or deep anterior lamellar keratoplasty.
本研究旨在评估单纯Bowman层（BL）移植治疗重度圆锥角膜的5年临床效果。
在一家三级转诊中心进行的这项前瞻性、单中心、介入性病例系列研究中，17例重度圆锥角膜患者的20只眼接受了BL移植，即将一片单纯Bowman层移植物置于手动剖切的基质中层袋内。术后长达5年，采用基于Scheimpflug的角膜断层扫描测量、最佳矫正眼镜和接触镜视力（最佳矫正视力和最佳矫正接触镜视力）、内皮细胞密度及并发症情况。
测量的模拟和最大角膜曲率（平均角膜曲率和最大角膜曲率）值在术后5年保持稳定（与术后1个月随访相比，5年时分别为P = 0.310和P = 0.195），术前至术后1个月有初始下降（各P < 0.001）。平均LogMAR最佳矫正视力在术后保持稳定（P > 0.99），术前至术后12个月有初始改善（P = 0.007）。平均最佳矫正接触镜视力从术前至术后5年未发生变化（P = 0.219）。在所有术后随访中，平均密度测量值均高于术前（P < 0.001）。术后4.5年有一只眼发生角膜水肿；未观察到其他术后并发症。Kaplan-Meier分析显示术后5年估计成功率为84%。内皮细胞密度从手术前至术后5年保持稳定（P = 0.319）。
术后早期角膜变平后，BL移植术后长达5年角膜地形图保持稳定，维持了最佳矫正接触镜视力和接触镜耐受性，可能使穿透性或深板层角膜移植术长期推迟。
