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Bowman Layer Onlay Transplantation to Manage Herpes Corneal Scar.

Authors
  • Dapena, Isabel1, 2
  • Musayeva, Aytan1, 2
  • Dragnea, Diana C1, 2
  • Groeneveld-van Beek, Esther A1, 3
  • Ní Dhubhghaill, Sorcha1, 2
  • Parker, Jack S4, 5
  • van Dijk, Korine1, 2
  • Melles, Gerrit R J1, 2, 3, 5
  • 1 Netherlands Institute for Innovative Ocular Surgery (NIIOS), Rotterdam, The Netherlands. , (Netherlands)
  • 2 Melles Cornea Clinic Rotterdam, The Netherlands. , (Netherlands)
  • 3 Amnitrans EyeBank Rotterdam, The Netherlands. , (Netherlands)
  • 4 Parker Cornea, Birmingham, AL.
  • 5 NIIOS-USA, San Diego, CA.
Type
Published Article
Journal
Cornea
Publication Date
Sep 01, 2020
Volume
39
Issue
9
Pages
1164–1166
Identifiers
DOI: 10.1097/ICO.0000000000002292
PMID: 32073454
Source
Medline
Language
English
License
Unknown

Abstract

To introduce the concept of using a Bowman layer (BL) onlay graft to manage superficial herpetic corneal scarring and to describe the clinical outcomes of the first 2 cases undergoing this procedure. Two patients with a quiescent superficial corneal scar after herpes (varicella zoster virus [n = 1] and herpes simplex virus [n = 1]) keratitis underwent BL onlay transplantation. After the removal of the host epithelium and limited superficial keratectomy, an isolated BL graft was placed onto the host corneal surface. The cornea was then covered with an amniotic membrane and a bandage contact lens. Best spectacle-corrected visual acuity (VA) and/or best contact lens-corrected VA (BCLVA), biomicroscopy, corneal tomography, and anterior segment optical coherence tomography were recorded at 1 week, 1 month, and 3, 6, 9, 12, and 18 months postoperatively. In both cases, the surgical and postoperative courses were uneventful. An improvement of the corneal clarity was observed at biomicroscopy, and no varicella zoster virus/herpes simplex virus reactivation occurred throughout the follow-up period. Biomicroscopy, Scheimpflug imaging, and anterior segment optical coherence tomography showed a completely epithelialized and well-integrated graft postoperatively. In case 1, BCLVA with a scleral lens improved from 20/100 (0.1) preoperatively to 20/32 (0.6) postoperatively. For case 2, no preoperative BCLVA was available, but a BCLVA of 20/36 (0.55) was achieved after the procedure. A BL onlay graft may be a feasible surgical procedure, which may have the potential to reduce superficial corneal scarring and/or anterior corneal irregularities without resorting to deeper keratoplasty in these complex cases.

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