Bowman Layer Transplantation With Stromal Inclusion Using Femtosecond Laser: 3-Year Results

Purpose:The aim of this study was to evaluate the 3-year clinical results of Bowman layer with stromal inclusion (Bowman layer) transplantation using femtosecond laser for patients with advanced keratoconus.Methods:This single-center retrospective study included 7 eyes of 7 patients diagnosed with progressive keratoconus who underwent Bowman layer transplantation with stromal inclusion between 2018 and 2020. Follow-up was carried out from the date of surgery until 36 months later. Bowman layer grafts were positioned into a mid-stromal pocket performed by a femtosecond laser and patients were evaluated up to 3 years after surgery.Results:Corneal flattening of 5.49 D (P = 0.0020) in Kmax was observed, increased in corneal pachymetry, and an improvement best-corrected visual acuity measured in logarithm of minimum angle of resolution (LogMAR) from 0.89 to 0.60 and tolerance to contact lens from 42% of the patients to 100% of them. Stabilization of the cornea was achieved in 100% with no further progression of the keratoconus; all surgical procedures were uneventful, and no complications were observed during the 3 years of follow-up.Conclusions:Bowman layer transplantation with stromal inclusion flattened the cornea improving best-corrected visual acuity and contact lens tolerance and stabilized keratoconus in 100% of the patients during 3 years of follow-up and may be a feasible option in patients with advanced and progressive KC to delay or avoid the need for PK or DALK.