Issue: November 2016
Perspective from Marjan Farid, MD
May 07, 2016
2 min read

Bowman’s layer transplantation improves visual outcomes in patients with keratoconus

Issue: November 2016
Perspective from Marjan Farid, MD
You've successfully added to your alerts. You will receive an email when new content is published.

Click Here to Manage Email Alerts

We were unable to process your request. Please try again later. If you continue to have this issue please contact

NEW ORLEANS — Visual outcomes improved in patients with advanced keratoconus who underwent Bowman’s layer transplantation, according to a speaker here.

“One thing that we all know is that in the early to intermediate phases of keratoconus, most of the visual dysfunction can be corrected by wearing a contact lens, but often with progression of disease may become so bulbously irregular that continued contact lens wear becomes either impossibly uncomfortable or simply ineffectual,” Jack S. Parker Jr., MD, said during Cornea Day preceding the American Society of Cataract and Refractive Surgery meeting.

Jack S. Parker

Patients are often recommended to undergo deep anterior lamellar keratoplasty (DALK) or penetrating keratoplasty (PK) for advanced keratoconus, he said.

“The problem with these operations is not that they don’t work, it’s that they are associated with so many potential complications,” Parker said.

Potential complications of DALK and PK are suture-related and wound healing problems, progression of disease and persistent irregular astigmatism in the graft.

The Bowman’s layer (BL) transplant is delivered into the midstroma of the keratoconic cornea, which then flattens the cornea and mechanically bolsters the cornea against further progression of ectasia.

Parker and colleagues conducted a study including 22 contact lens intolerant eyes of 19 patients who received an isolated BL graft into their midstroma. Patients were followed for 4 to 5 years.

The purpose of the study was for patients to have significant flattening and stabilization of the cornea, to be able to wear a contact lens after the procedure and to avoid complications associated with DALK and PK.

Mean corneal flattening was 9 D in patients who underwent BL transplantation after 4 years, and 90% of patients have experienced arrested progression of keratoconus through 5 years.

Furthermore, all patients were restored in their ability to wear contact lenses, he said.

Many patients experienced an improvement in their best spectacle corrected vision, with normalization of the ocular surface and no reported postoperative complications, he said. – by Nhu Te


Parker J. Bowman’s layer transplant. Presented at: ASCRS; May 6-10, 2016; New Orleans, Louisiana.

Disclosure: Parker reports no relevant financial disclosures.