Bowman layer onlay transplantation in the management of epithelial-stromal dystrophies of Reis — Bücklers and Thiel — Behnke

Epithelial-stromal dystrophies (ESD) are bilateral, genetically determined, progressive corneal diseases, in all cases accompanied by destruction of the Bowman’s layer. The operation of first choice is superficial keratectomy, but the risk of recurrence is always high. Purpose of the work: to evaluate the effectiveness of Bowman’s layer transplantation in the complex treatment of Reis — Bücklers and Thiel — Behnke dystrophies. Material and methods. The study is pilot, limited, prospective, monocentric. Four eyes of three patients aged 32 ± 9 years with primary and recurrent ESD were operated on. The follow-up period was 24 months. The examination included biomicroscopy, visometry, keratanalysis, optical coherence tomography of the cornea. The surgical technique included excimer laser ablation, mitomycin C application and Bowman’s layer transplantation. Complications, best-corrected visual acuity, corneal transparency, and relapse rate were assessed. Results. There were no intraoperative or postoperative complications. No signs of relapse were noted within 24 months, the cornea and transplant remained transparent. The average best-corrected visual acuity increased from 0.1 ± 0.1 to 0.5 ± 0.1, the average central corneal thickness after 24 months was 545 ± 44 μm. Conclusion. Bowman’s layer transplantation in the complex treatment of Reis — Bücklers and Thiel — Behnke dystrophies makes it possible to easily restore the anatomy of the anterior corneal surface after laser ablation and avoid significant corneal thinning. The technique is simple, ensures restoration of corneal transparency and the absence of relapses within the available observation periods, and does not increase the need for donor tissue. For greater objectivity, it is necessary to increase the number of clinical cases and observation periods.