Our Summary

This research paper is about a new procedure called Bowman layer transplantation, which can help people with advanced keratoconus, a disease that changes the shape of the eye’s cornea. The treatment could be a good option for people whose corneas are too steep or thin for other treatments. The procedure could help these people keep their vision stable with contact lenses and avoid or delay the need for more invasive cornea transplants. The paper reviews current research on Bowman layer transplantation, which suggests that it’s a promising treatment with an 84% success rate over five years. It allows patients to have good vision with the help of glasses or contact lenses. While preparing the graft and performing the procedure can be difficult, new technologies may help overcome these challenges and make the procedure more common. The study concludes that Bowman layer transplantation could be a less invasive alternative for treating advanced keratoconus.

FAQs

  1. What is the new procedure discussed in the research paper for treating advanced keratoconus?
  2. What is the success rate of Bowman layer transplantation over five years?
  3. What challenges are associated with Bowman layer transplantation and how might new technologies help overcome them?

Doctor’s Tip

A doctor might tell a patient considering a corneal transplant to make sure they follow all post-operative care instructions carefully, including taking any prescribed medications and attending all follow-up appointments. It’s important to protect the eye from injury or infection during the healing process to ensure the best possible outcome. Additionally, patients should communicate any concerns or changes in vision to their doctor promptly to address any potential complications.

Suitable For

Patients who are typically recommended for corneal transplant include those with:

  1. Keratoconus: a progressive condition that causes the cornea to thin and bulge outward, leading to distorted vision.

  2. Fuchs’ dystrophy: a condition in which cells in the inner layer of the cornea gradually die off, leading to swelling and cloudy vision.

  3. Corneal scarring: caused by injury, infection, or previous eye surgery, leading to reduced vision.

  4. Corneal degenerations: such as lattice dystrophy or map-dot-fingerprint dystrophy, which can cause vision problems.

  5. Corneal ulcers: deep, open sores on the cornea that can cause pain, redness, and vision loss.

  6. Corneal swelling: due to conditions such as bullous keratopathy, leading to distorted vision.

  7. Corneal dystrophies: inherited conditions that affect the cornea, such as granular dystrophy or macular dystrophy.

  8. Previous corneal transplant failure: in cases where a previous corneal transplant has failed, a repeat transplant may be recommended.

Overall, patients with corneal conditions that cannot be effectively treated with other methods, such as medications or contact lenses, may be recommended for a corneal transplant. It is important for patients to consult with their eye care provider to determine the best course of treatment for their specific condition.

Timeline

Before a corneal transplant:

  1. Diagnosis: The patient is diagnosed with a condition such as keratoconus, where the cornea becomes thin and cone-shaped, affecting vision.
  2. Treatment options: The patient may have tried other treatments such as glasses, contact lenses, or corneal cross-linking to stabilize their vision.
  3. Evaluation: The patient undergoes a thorough evaluation to determine if they are a suitable candidate for a corneal transplant.
  4. Waiting list: If deemed eligible, the patient is placed on a waiting list for a donor cornea that matches their specific needs.

After a corneal transplant:

  1. Surgery: The patient undergoes the corneal transplant surgery, where a donor cornea is placed onto their eye to replace the damaged or diseased cornea.
  2. Recovery: The patient will need to follow post-operative care instructions to ensure proper healing and reduce the risk of complications.
  3. Follow-up appointments: The patient will have regular follow-up appointments with their ophthalmologist to monitor the success of the transplant and make any necessary adjustments.
  4. Vision improvement: Over time, the patient’s vision may improve as the transplanted cornea integrates and stabilizes.
  5. Long-term care: The patient will need to continue regular eye exams and follow-up care to monitor the health of the transplanted cornea and address any issues that may arise.

What to Ask Your Doctor

  1. What is Bowman layer transplantation and how does it differ from traditional corneal transplants?
  2. Am I a candidate for Bowman layer transplantation? What criteria do I need to meet in order to be eligible for this procedure?
  3. What are the potential risks and complications associated with Bowman layer transplantation?
  4. What is the success rate of Bowman layer transplantation compared to traditional corneal transplants?
  5. How long is the recovery process after Bowman layer transplantation and what can I expect in terms of post-operative care?
  6. Will I still need to wear contact lenses or glasses after undergoing Bowman layer transplantation?
  7. How long does the effect of Bowman layer transplantation last? Will I need additional treatments in the future?
  8. Are there any alternative treatments for advanced keratoconus that I should consider before opting for Bowman layer transplantation?
  9. How experienced are you in performing Bowman layer transplantation and what is your success rate with this procedure?
  10. What is the cost of Bowman layer transplantation and will my insurance cover the procedure?

Reference

Authors: Tong CM, van Dijk K, Melles GRJ. Journal: Curr Opin Ophthalmol. 2019 Jul;30(4):249-255. doi: 10.1097/ICU.0000000000000570. PMID: 31033731