Several treatment options corresponding to the grade of keratoconus have been established.These are ultra-violet corneal crosslinking and intracorneal ring segments for mild to moderate keratoconus,and penetrating ker...Several treatment options corresponding to the grade of keratoconus have been established.These 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 keratoconus.Bowman layer transplantation was developed as a procedure for patients with advanced,progressive keratoconus.The 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 ectasia.Thus,it aims at corneal stabilization in eyes with advanced keratoconus,and enabling continued contact lens wear for normal visual functionality.By being a sutureless procedure and using an acellular graft,it potentially avoids commonly known suture and graftrelated complications of penetrating or deep anterior lamellar keratoplasty.The 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.展开更多
Background:To evaluate the efficacy of manual mid-stromal dissection in stabilizing progressive keratoconus.Methods:Surgeries were performed in 16 eyes of 14 patients with progressive keratoconus.All eyes were examine...Background:To evaluate the efficacy of manual mid-stromal dissection in stabilizing progressive keratoconus.Methods:Surgeries were performed in 16 eyes of 14 patients with progressive keratoconus.All eyes were examined before and at 1 day,1 week,1,3,6 and 12 months after surgery,and every 6 months thereafter.Pentacam(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 occurred.Keratometry values(n=15)stabilized in 6/11 eyes(55%)with a preoperative Kmax<60.0 diopter(D),while all eyes>60 D showed continued progression.In 11/15 eyes(73%)pachymetry was unchanged.BCVA 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 transplantation.An advantage of the procedure may be that the tissue is unaltered and that no synthetic or biological implant is required.展开更多
文摘Several treatment options corresponding to the grade of keratoconus have been established.These 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 keratoconus.Bowman layer transplantation was developed as a procedure for patients with advanced,progressive keratoconus.The 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 ectasia.Thus,it aims at corneal stabilization in eyes with advanced keratoconus,and enabling continued contact lens wear for normal visual functionality.By being a sutureless procedure and using an acellular graft,it potentially avoids commonly known suture and graftrelated complications of penetrating or deep anterior lamellar keratoplasty.The 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.
文摘Background:To evaluate the efficacy of manual mid-stromal dissection in stabilizing progressive keratoconus.Methods:Surgeries were performed in 16 eyes of 14 patients with progressive keratoconus.All eyes were examined before and at 1 day,1 week,1,3,6 and 12 months after surgery,and every 6 months thereafter.Pentacam(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 occurred.Keratometry values(n=15)stabilized in 6/11 eyes(55%)with a preoperative Kmax<60.0 diopter(D),while all eyes>60 D showed continued progression.In 11/15 eyes(73%)pachymetry was unchanged.BCVA 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 transplantation.An advantage of the procedure may be that the tissue is unaltered and that no synthetic or biological implant is required.
