Bowman's layer transplantation—A new hope for regaining of correct ocular surface

Abstract

Aims/Purpose: To present a novel surgical technique of selective Bowman's layer transplantation as well as results of the surgery in patients with neurotrophic corneal ulcers.Methods: 3 eyes from 3 patients with neurotrophic corneal ulcers who underwent corneal grafting with Bowman's layer. Pre‐ and postoperative analyses of the anterior segment of the eye were based on optical coherence tomography and slit lamp assessment.Results: Postoperatively a gradual corneal stroma restoration and fast corneal epithelialisation were noticed.Conclusions: Based on our observations, stiff and firm structure of Bowman's layer is supposed to strengthen corneal surface and maintain its shape. It acts also as an anti‐pathogen and anti‐toxin corneal barrier. Application of this acellular corneal layer transplantation to cover trophic corneal ulcers is an interesting, modern and crucial method of neurotrophic keratitis treatment.Reference1. Hsu HY, Modi D. Etiologies, quantitative hypoesthesia, and clinical outcomes of neurotrophic keratopathy. Eye Contact Lens 2015;41(5):314–7.2. Sacchetti M, Lambiase A. Diagnosis and management of neurotrophic keratitis. Clin Ophthalmol 2014;8:571–9.3. Mantelli F, Mauris J, Argüeso P. The ocular surface epithelial barrier and other mechanisms of mucosal protection: from allergy to infectious diseases. Curr Opin Allergy Clin Immunol. 2013 Oct;13(5): 563–8.4. Wilson SE. Bowman's layer in the cornea‐ structure and function and regeneration. Exp Eye Res 2020 Jun;195:108033.5. Lagali N, Germundsson J, Fagerholm P. The Role of Bowman's Layer in Corneal Regeneration after Phototherapeutic Keratectomy: A Prospective Study Using In Vivo Confocal Microscopy. Invest Ophthalmol Vis Sc. 2009 Sep;50(9):4192–8.