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Bowman’s layer transplantation in advanced keratoconus; 18-months outcomes

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Abstract

Purpose

To assess the outcome of isolated Bowman’s layer transplantation (BLT) in advanced keratoconus in the patients not suitable for ultra violet cross-linking and intra stromal corneal ring segments.

Study design

Nonrandomized Quasi-Experimental.

Materials and methods

Mid corneal stromal dissection followed by implantation of manually isolated bowman layer from a donor into the recipient stromal pocket was performed in the Department of Ophthalmology Khyber Teaching Hospital Peshawar from September 2018 to October 2018 and followed up over 18 months.

Results

Eleven eyes of 11 patients, 8 male and 3 female within the age range of 7–28 years with progressive keratoconus went under BLT All keratometry values decreased after surgery. Mean anterior pre-operative SimK changed from 69.05 ± 10.85 D to 61.14 ± 6.23 D at 18 months post-operatively (P = 0.005). Means pre-operative Kmax value decreased from 77.24 ± 7.58 D to 71.07 ± 5.37 D at 18 months post-operatively (p = 0.060). The mean pre-operative posterior keratometry value changed from − 10.03 ± 0.88 to − 8.96 ± 1.06 D at 18 months post-operatively (P = 0.002). Mean pre-operative thinnest corneal thickness increased from 281.64 ± 196.86 um to 355.27 ± 19.17 um at 18th months post-operatively (P = 0.001). Pachymetry p-value pre-operative to 18 months (P = 0.001) was statistically significant. Mean anterior SimK at 6 months post-operatively, 60.55 ± 5.56D changed to 61.14 ± 6.23D at 18 months post-operatively (P = 0.000), Kmax at 6 months postoperative 71.60 ± 5.01 D changed to 71.07 ± 5.37 D at 18 months post-operatively (P = 0.008). Both anterior K values at 6 months and 18 months post-operatively showed less significant change, and the same was true for Kmax data at 6 months and 18 months post-operatively. P-values at 6 months to 18 months post-operatively for cornea back data remained (P = 0.001) unchanged. No complications were observed intra-operatively or post-operatively.

Conclusion

Bowman layer transplantation is a unique surgical treatment for advanced keratoconus to stabilize progressive ectasia with fewer complications avoiding the need for penetrating or deep anterior lamellar keratoplasty.

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Funding

The study was conducted with our resources.

Author information

Authors and Affiliations

  1. Department of Ophthalmology, Khyber Teaching Hospital, Flat no. 13, new doctor flat, Peshawar, 25000, Pakistan

    Zaman Shah, Ibrar Hussain & Bakht Samar Khan

  2. Department of Eye & Visual Sciences, University of Liverpool, Liverpool, England, UK

    Davide Borroni

  3. Dow University of Health Sciences, Karachi, Pakistan

    Shahid Wahab

  4. Aga Khan University Hospital, Karachi, Pakistan

    Pir Salim Mahar

Authors
  1. Zaman Shah
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  2. Ibrar Hussain
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  3. Davide Borroni
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  4. Bakht Samar Khan
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  5. Shahid Wahab
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  6. Pir Salim Mahar
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Contributions

Zaman Shah: Main scriptwriter. Ibrar Hussain: Data Analysis. Davide Borroni: Collection of references. Bakht Samar Khan: Data collection. Shahid Wahab and Pir Salim Mahar: Main script reviewer.

Corresponding author

Correspondence to Zaman Shah.

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Conflict of interest

All authors report no conflict of interest.

Ethical approval

Ethical approval of the study was obtained from the institutional research and ethical review board (IREB) of Khyber Medical College Peshawar in accordance with the declaration of Helsinki (No: 807/ADR/KMC).

Informed consent

The informed written consent was obtained from all the patients.

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Consent was taken through email.

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Shah, Z., Hussain, I., Borroni, D. et al. Bowman’s layer transplantation in advanced keratoconus; 18-months outcomes. Int Ophthalmol 42, 1161–1173 (2022). https://doi.org/10.1007/s10792-021-02101-8

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  • DOI: https://doi.org/10.1007/s10792-021-02101-8

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