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Update on Bowman layer transplantation

Tong, C. Mayaa,b; van Dijk, Koninea,c; Melles, Gerrit R.J.a,c,d

Current Opinion in Ophthalmology: July 2019 - Volume 30 - Issue 4 - p 249–255
doi: 10.1097/ICU.0000000000000570

Purpose of review Bowman layer transplantation is a novel technique that may stabilize progressive ectatic corneal changes in eyes with keratoconus, which are too steep or too thin for ultraviolet corneal crosslinking or intracorneal ring segments. In this way, patients can maintain stable vision with contact lenses, and avoid or postpone more invasive corneal transplants, such as penetrating keratoplasty or deep anterior lamellar keratoplasty. This review aims to summarize the currently available literature on Bowman layer transplantation.

Recent findings Bowman layer transplantation seems to be a promising, minimally invasive procedure for managing advanced keratoconus with a reported 5-year success rate of 84%. The procedure allows patients to maintain acceptable visual acuity with glasses or contact lens correction. Although graft preparation and surgical technique can be challenging, adaptation of technologies, such as femtosecond laser and intraoperative anterior segment optical coherence tomography, may help overcome these barriers to enable Bowman layer transplantation to become a more widely adopted procedure.

Summary Bowman layer transplantation may offer an alternative, less invasive treatment option for eyes with advanced, progressive keratoconus.

aNetherlands Institute for Innovative Ocular Surgery (NIIOS), Rotterdam, The Netherlands

bUniversity of Alberta, Canada

cMelles Cornea Clinic Rotterdam, The Netherlands

dNIIOS-USA, San Diego, USA

Correspondence to Gerrit R.J. Melles, MD, PhD, Netherlands Institute for Innovative Ocular Surgery (NIIOS), Laan op Zuid 88, 3071AA Rotterdam, The Netherlands. Tel: +31 10 297 4444; fax: +31 10 297 4440; e-mail:

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