Our Summary

This research paper discusses a severe and rare side effect of Bowman Layer Transplantation (BLT), a surgical procedure used to treat advanced keratoconus, a degenerative eye condition. A 35-year-old woman with Down syndrome underwent this procedure. Everything seemed fine at first, as the surgery went smoothly and her recovery was stable. Her eye even showed signs of improvement. However, about two and a half weeks after the procedure, she developed a condition called sterile corneal necrosis, a serious complication that involves the death of eye tissue. This particular complication had not been previously reported in relation to BLT. The researchers suggest several possible reasons for this unexpected outcome in the paper.

FAQs

  1. What is Bowman Layer Transplantation (BLT) and what is it used for?
  2. What is sterile corneal necrosis and how serious is it?
  3. Has sterile corneal necrosis been previously reported as a side effect of Bowman Layer Transplantation?

Doctor’s Tip

One helpful tip a doctor might give a patient about corneal transplant is to closely follow post-operative care instructions to reduce the risk of complications. This can include using prescribed eye drops, avoiding rubbing or putting pressure on the eye, protecting the eye from injury, and attending follow-up appointments to monitor healing progress. It’s important to promptly report any changes in vision, pain, or discomfort to your doctor to address any issues early on.

Suitable For

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

  1. Corneal scarring or clouding: This may be due to previous eye injuries, infections, or conditions such as keratoconus.

  2. Corneal thinning: Conditions such as keratoconus or corneal ectasia can cause the cornea to become thin and weak, leading to vision problems.

  3. Corneal dystrophies: Inherited conditions that cause progressive damage to the cornea, such as Fuchs’ dystrophy or lattice dystrophy, may require a corneal transplant.

  4. Corneal ulcers: Severe infections or injuries to the cornea may not heal properly, leading to vision loss and the need for a transplant.

  5. Corneal swelling: Conditions such as endothelial dysfunction can cause the cornea to become swollen and cloudy, affecting vision.

  6. Previous failed corneal surgeries: If previous attempts to correct corneal issues have been unsuccessful, a corneal transplant may be recommended.

  7. Contact lens intolerance: Some patients with corneal conditions may not be able to tolerate contact lenses, making a corneal transplant the best option for improving vision.

It is important for patients considering a corneal transplant to undergo a thorough evaluation by an ophthalmologist to determine if they are a suitable candidate for the procedure.

Timeline

Before corneal transplant:

  1. Patient is diagnosed with a corneal condition such as keratoconus or Fuchs’ dystrophy.
  2. Patient undergoes a thorough evaluation by an ophthalmologist to assess their suitability for a corneal transplant.
  3. Patient is placed on a waiting list for a suitable donor cornea.
  4. Patient undergoes pre-operative tests and evaluations to ensure they are healthy enough for surgery.
  5. Patient receives information about the procedure and what to expect during the recovery process.

After corneal transplant:

  1. Patient undergoes the corneal transplant surgery, during which the damaged or diseased cornea is replaced with a healthy donor cornea.
  2. Patient is monitored closely in the immediate post-operative period for any signs of complications.
  3. Patient may experience blurred vision, discomfort, and sensitivity to light in the days and weeks following the surgery.
  4. Patient is prescribed a regimen of eye drops to prevent infection and promote healing.
  5. Patient attends follow-up appointments with their ophthalmologist to monitor the healing process and assess the success of the transplant.
  6. Patient gradually experiences improved vision as the transplanted cornea integrates with the surrounding tissue.
  7. Patient may need to undergo additional procedures or adjustments to optimize the outcome of the transplant.
  8. Patient may eventually achieve improved vision and quality of life as a result of the successful corneal transplant.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with corneal transplant surgery?

  2. How likely is it for complications such as sterile corneal necrosis to occur after a corneal transplant procedure?

  3. What are the signs and symptoms of sterile corneal necrosis that I should watch out for after the surgery?

  4. What is the recommended post-operative care regimen to minimize the risk of complications like sterile corneal necrosis?

  5. How will my overall health and any pre-existing conditions, such as Down syndrome, impact the success and potential complications of the corneal transplant surgery?

  6. Are there any alternative treatment options available for my condition that may have lower risks of complications?

  7. How experienced is the surgical team in performing corneal transplant surgeries, and what is their success rate with similar cases?

  8. What is the long-term prognosis for my vision following a corneal transplant surgery?

  9. How frequently will I need to follow up with my doctor after the surgery, and what signs should prompt me to seek immediate medical attention?

  10. Are there any lifestyle changes or precautions I should take to ensure the best possible outcome and minimize the risk of complications following the surgery?

Reference

Authors: Orive Bañuelos A, Santamaría Carro A, Feijóo Lera R, Etxebarria Ecenarro J. Journal: Eur J Ophthalmol. 2023 Jul;33(4):1558-1566. doi: 10.1177/11206721231165438. Epub 2023 Mar 21. PMID: 36945822