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Bowman layer transplantation in the treatment of keratoconus

Eye and Vision 2018年第1期5卷 217-222页

作者： Diana C.Dragnea Rénuka S.Birbal lisanne ham Isabel Dapena Silke Oellerich Korine van Dijk Gerrit R.J.Melles Netherlands Institute for Innovative Ocular Surgery(NIIOS) Laan op Zuid 883071AA RotterdamThe Netherlands Melles Cornea Clinic RotterdamThe Netherlands. Amnitrans EyeBank RotterdamThe Netherlands NIIOS-USA San DiegoUSA

Several treatment options corresponding to the grade of keratoconus have been *** are ultra-violet corneal crosslinking and intracorneal ring segments for mild to moderate keratoconus,and penetrating keratoplasty or deep anterior lamellar keratoplasty for the more advanced cases of *** layer transplantation was developed as a procedure for patients with advanced,progressive *** technique consists of transplanting an isolated donor Bowman layer into a mid-stromal pocket of a keratoconic cornea resulting in corneal flattening and stabilization against further ***,it aims at corneal stabilization in eyes with advanced keratoconus,and enabling continued contact lens wear for normal visual *** being a sutureless procedure and using an acellular graft,it potentially avoids commonly known suture and graftrelated complications of penetrating or deep anterior lamellar *** treatment seems to be a promising option in the management of advanced keratoconus in order to postpone or prevent a more invasive corneal surgery,while minimizing the risk of complications and allowing less stringent surveillance and less intensive medical therapy.

关键词： Cornea Advanced keratoconus Bowman layer Penetrating keratoplasty Deep anterior lamellar keratoplasty Crosslinking Intracorneal ring segments

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Manual mid-stromal dissection as a low risk procedure to stabilize mild to moderate progressive keratoconus

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Eye and Vision 2018年第1期5卷 233-239页

作者： Rénuka S Birbal Korine van Dijk Jack S Parker Henny Otten Maha Belmoukadim lisanne ham Lamis Baydoun Isabel Dapena Gerrit R J Melles Netherlands Institute for Innovative Ocular Surgery(NIIOS)Rotterdam Laan op Zuid 883071AA RotterdamThe Netherlands Melles Cornea Clinic Rotterdam RotterdamThe Netherlands Amnitrans EyeBank Rotterdam RotterdamThe Netherlands. NIIOS-USA San DiegoUSA Parker Cornea BirminghamALUSA Visser Contact Lens Practice Nijmegen/Rotterdam RotterdamThe Netherlands

Background:To evaluate the efficacy of manual mid-stromal dissection in stabilizing progressive ***:Surgeries were performed in 16 eyes of 14 patients with progressive *** eyes were examined before and at 1 day,1 week,1,3,6 and 12 months after surgery,and every 6 months ***(simK,Kmax and pachymetry),best corrected visual acuity(BCVA)and subjective refraction were recorded up to the latest follow-up visit(mean follow-up time 6.6±2.4 years).Results:All surgeries were uneventful,and no postoperative complications *** values(n=15)stabilized in 6/11 eyes(55%)with a preoperative Kmax60 D showed continued *** 11/15 eyes(73%)pachymetry was *** with spectacles remained stable in 7/12 eyes(58%)and improved≥2 Snellen lines in 5/12 eyes(42%).BCVA with a contact lens remained stable in 4/9 eyes(44%),improved≥2 Snellen lines in 3/9 eyes(33%)and deteriorated in 2/9 eyes(22%).Conclusions:Manual mid-stromal dissection was effective in 50%of keratoconic corneas with Kmax values<60 D and may be considered in cases ineligible for other interventions such as UV-crosslinking,stromal ring implantation or Bowman layer *** advantage of the procedure may be that the tissue is unaltered and that no synthetic or biological implant is required.

关键词： Keratoconus Manual cornea dissection Progressive ectasia Surgical technique

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