Bowman layer transplantation using a femtosecond laser

Oteyza, G. García de; Dibildox, Laura Alejandra González; Vázquez-Romo, K.A.; Vázquez, André Tapia; Alquisiras, Jesus Heriberto Davila; Martínez-Báez, Blanca E.; García-Albisua, Ana Mercedes; Ramı́rez, Manuel; Hernández-Quíntela, Everardo

doi:10.1016/j.jcrs.2018.10.034

Cited by 27 publications

(53 citation statements)

References 34 publications

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“…In the past decade, isolated BL transplantation has been described as an alternative to PK and DALK for patients with advanced KC [112, 113]. Because the BL graft is acellular and is implanted in a suture-less fashion within the corneal stroma of the recipient eye, many of the limitations and complications of PK and DALK may be avoided.…”

Section: Anterior Lamellar Keratoplastymentioning

confidence: 99%

“…In addition, because the BL graft may stabilize and flatten the recipient cornea, many of the advantages of UVCXL and ICRS may be captured and applied to eyes in which these procedures would normally be contraindicated. However, one of the major obstacles for the popularity of this surgery is the difficulty of a midstromal dissection in extremely thin, severely ectatic corneas; therefore, efforts to automate this step with a femtosecond laser have been attempted, and while this technique may offer a safer and more accurate stromal dissection, longer-term results are needed to assess its effects on corneal curvature [112].…”

Section: Anterior Lamellar Keratoplastymentioning

confidence: 99%

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Descemet Membrane Endothelial Keratoplasty and Bowman Layer Transplantation: An Anatomic Review and Historical Survey

et al. 2021

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For nearly a century, the definitive treatment of many corneal dystrophies and ectactic disorders was limited to penetrating keratoplasty, but over the past 2 decades, a surge of surgical innovation has propelled the treatment of many corneal diseases to more targeted approaches with significantly better visual outcomes. Anterior stromal diseases were first changed through endothelial-sparing techniques, such as deep anterior lamellar keratoplasty, but have more recently transitioned to stromal-sparing approaches. Ultraviolet corneal crosslinking strengthens the cornea and halts progression of keratoconus in >90% of cases. Intracorneal ring segment and corneal allogenic ring segment implantation offer methods to flatten ectatic corneas. However, Bowman layer transplantation – inlay and more recently onlay techniques – has shown promise for treating advanced keratoconus and preventing keratoplasty. The advent of endothelial keratoplasty radically changed the treatment of corneal endothelial dysfunction, and Descemet membrane endothelial keratoplasty specifically offers an average postoperative visual acuity of 20/25 (0.8) with only 8.8% of grafts requiring retransplantation in the first 5 years. Here, we review the rapid innovations for surgical treatment of corneal diseases, spanning from endothelial keratoplasty and endothelial regeneration to anterior lamellar keratoplasty and stromal augmentation, highlighting key steps which may be moving us closer to a “postkeratoplasty” world.

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Section: Anterior Lamellar Keratoplastymentioning

confidence: 99%

Section: Anterior Lamellar Keratoplastymentioning

confidence: 99%

Descemet Membrane Endothelial Keratoplasty and Bowman Layer Transplantation: An Anatomic Review and Historical Survey

et al. 2021

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“…This procedure may postpone penetrating keratoplasty (PK) or deep anterior lamellar keratoplasty (DALK) and potentially allowed long term contact lens wear [71]. Although graft preparation and surgical technique can be challenging, assisted technologies, such as femtosecond laser and intraoperative anterior segment optical coherence tomography (OCT), may help conquer these barriers [78,79]. "Bowman layer onlay," a recently developed surgical technique in which an isolated Bowman's layer graft, is positioned onto the patient's anatomical Bowman's layer or anterior stroma, has demonstrated the rapid re-epithelization and integration of the tissue and comparable clinical outcomes to intrastromal transplantation [80].…”

Section: Bowman Layer Transplantationmentioning

confidence: 99%

Keratoconus Treatment Toolbox: An Update

Roongpoovapatr¹,

Shousha²,

Charukamnoetkanok³

2020

Eyesight and Medical Image Cognition - Recent Advances and New Perspectives [Working Title]

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Keratoconus is a bilateral, asymmetric, progressive disease of the cornea which can lead to visual impairment and blindness as irregular astigmatism increases and corneal scar occurs. Currently, many methods are available for a treatment of keratoconus. The treatment can help enhance visual rehabilitation and prevent progression in keratoconus patients. The treatment options included non-surgical and surgical managements. This review offers a summary of the current and emerging treatment options for keratoconus- eyeglasses, contact lens, corneal collagen cross-linking (CXL), CXL Plus, intrastromal corneal ring segment (ICRS), Corneal Allogenic Intrastromal Ring Segments (CAIRS), Penetrating Keratoplasty (PK), Deep Anterior Lamellar Keratoplasty (DALK), Bowman layer transplantation (BL transplantation) and gene therapy.

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“…Manual preparation of the grafts is technically challenging with a 30% failure rate. 12 The implantation of the isolated Bowman layer involves creating an intra-stromal pocket, which can be difficult in cases with advanced corneal thinning and can result in corneal perforation. A femtosecond laser has been recently used for creating the pocket to avoid this complication.…”

Section: Introductionmentioning

confidence: 99%

“…A femtosecond laser has been recently used for creating the pocket to avoid this complication. 12 As the demand for donor corneas exceeds the supply, other strategies have been investigated. Swine have similar ocular anatomy and physiology, which is why they are used to model ocular diseases and develop novel therapies.…”

Section: Introductionmentioning

confidence: 99%

Safety and Indicative Effectiveness of Porcine Corneal Lenticular Implants in Patients with Advanced Keratoconus and Post Lasik Ectasia: A Retrospective Clinical Study

Elmassry¹,

Ibrahim²,

Abdalla³

et al. 2021

OPTH

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This study aimed to evaluate the safety and feasibility of implanting decellularized porcine corneal lenticules in a femtosecond laser-assisted pocket for patients with advanced keratoconus and post-Lasik ectasia. Methods: This is a retrospective clinical study of implanting a porcine corneal lenticular implant in seven eyes: six with advanced keratoconus and clear cornea and one with advanced post-Lasik ectasia with a follow-up for 12 months. The lenticules are extracted from porcine tissue, subjected to a decellularization process, intensely cross-linked, sterilized and packed. They are 7 mm in diameter with at 100-120-micron thickness. The femtosecond laser was used to create an intra-stromal pocket, and then the lenticules were implanted inside the pocket followed by corneal cross-linking 3 months later for six out of seven eyes. Results: Five patients had keratoconus (6 eyes) and one patient (one eye) had post-Lasik ectasia. Visual acuity improved in all patients except for one case at 6 and 12 months and this was statistically significant (P=0.002 and 0.007). At one-year follow-up, the mean central corneal thickness increased from 389.43 ± 45.41 to 429.33± 63.20 µm, the maximum keratometry decreased from 64.8 ±5.11 to 62.82± 6.16 D, the mean corneal resistance factor (CRT) increased from 5.67 to 8.42, and the total higher-order aberrations decreased from 1.80 to 1.16. Both changes in the CCT and CRF were statistically significant. One eye had wrinkles and opacified graft, and it was exchanged 3 months postoperatively. Conclusion: Porcine corneal lenticules implantation is immunologically safe and well tolerated in patients with advanced keratoconus and post-Lasik ectasia and may be feasible as an alternative to keratoplasty.

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Bowman layer transplantation using a femtosecond laser

Cited by 27 publications

References 34 publications

Descemet Membrane Endothelial Keratoplasty and Bowman Layer Transplantation: An Anatomic Review and Historical Survey

Descemet Membrane Endothelial Keratoplasty and Bowman Layer Transplantation: An Anatomic Review and Historical Survey

Keratoconus Treatment Toolbox: An Update

Safety and Indicative Effectiveness of Porcine Corneal Lenticular Implants in Patients with Advanced Keratoconus and Post Lasik Ectasia: A Retrospective Clinical Study

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