Netherlands Institute for Innovative Ocular Surgery, Rotterdam, the Netherlands.
Melles Cornea Clinic Rotterdam, the Netherlands.
Cornea. 2021 Dec 1;40(12):1561-1566. doi: 10.1097/ICO.0000000000002740.
The aim of this study was to describe a new surgical technique for flattening the corneal curvature and to reduce progression in eyes with advanced progressive keratoconus (KC) by using Bowman layer (BL) onlay grafting and to report on the preliminary outcomes of this procedure.
In this prospective interventional case series, 5 patients with advanced progressive KC underwent BL onlay grafting. After removal of the epithelium, a BL graft was placed and "stretched" onto the stroma, and a bandage lens was placed to cover the BL graft. In 1 case, BL onlay grafting could be performed immediately after ultraviolet corneal crosslinking; all other eyes were ineligible for ultraviolet corneal crosslinking. Best spectacle- and/or best contact lens-corrected visual acuity, refraction, biomicroscopy, corneal tomography, anterior segment optical coherence tomography, and complications were recorded at 1 week and at 1, 3, 6, 9, and 12 to 15 months postoperatively.
All 5 surgeries could be performed successfully. Average maximum keratometry went from 75 diopters (D) preoperatively to 70 D at 1 year postoperatively. All eyes showed a completely reepithelialized and a well-integrated graft. Best spectacle-corrected visual acuity improved at least 2 Snellen lines (or more) in 3 of 5 cases and best contact lens-corrected visual acuity remained stable, improving by 3 Snellen lines in case 1 at 15 months postoperatively. Satisfaction was high, and all eyes again had full contact lens tolerance.
BL onlay grafting may be a feasible surgical technique, providing up to -5 D of corneal flattening in eyes with advanced KC.
本研究旨在描述一种新的手术技术，通过使用 Bowman 层（BL）覆盖移植来使角膜曲率变平，并减少进展性圆锥角膜（KC）的进展，报告该手术的初步结果。
在这项前瞻性干预性病例系列研究中，5 例进展性 KC 患者接受了 BL 覆盖移植。去除上皮后，放置 BL 移植物并“拉伸”到基质上，并放置绷带镜覆盖 BL 移植物。在 1 例中，BL 覆盖移植可在紫外线角膜交联后立即进行；所有其他眼睛均不符合紫外线角膜交联条件。在术后 1 周、1、3、6、9 和 12 至 15 个月时，记录最佳矫正视力、屈光度、生物显微镜检查、角膜断层扫描、眼前节光学相干断层扫描和并发症。
所有 5 例手术均成功完成。平均最大角膜曲率从术前的 75 屈光度（D）降至术后 1 年的 70 D。所有眼睛均表现出完全上皮化和良好整合的移植物。5 例中有 3 例最佳矫正视力至少提高了 2 行（或更多），1 例最佳矫正视力在术后 15 个月提高了 3 行，保持稳定。满意度高，所有眼睛再次完全耐受隐形眼镜。
BL 覆盖移植可能是一种可行的手术技术，可为进展性 KC 眼提供高达 -5 D 的角膜平坦化。
