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Subspecialties Cornea/Ocular Surface, Refractive

Bowman + Bulk = Better Results

At a Glance

  • Advanced keratoconus can be managed and treated with many methods – but all have drawbacks: the challenge is to minimize them
  • Keratoplasty is an option of last resort – but PK and DALK sacrifice much of the host cornea
  • Bowman’s layer transplantation (BLT) and placement into a mid-stromal pocket is a potentially tissue-sparing approach. It might restore some corneal architecture – but it doesn’t address the primary problem of apical stromal thinning
  • We describe a mid-stromal lamellar keratoplasty technique (MSLK) that both increases central corneal bulk and thickness, and flattens the cornea more than BLT, and describe the first clinical application of MSLK

There are several ways to treat keratoconus today, but none are perfect – each approach comes with drawbacks or limitations. Take corneal collagen cross-linking, which has revolutionized the field because of its ability to strengthen the cornea and slow progression (1) – and even flatten it slightly (2). But it’s never going to restore the corneal architecture, so your patients’ often highly debilitating visual symptoms remain.

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About the Author

Mohammad Khan

Mohammad Khan is a Corneal Fellow, Priscilla Mathewson is a Specialist Registrar, and Sunil Shah is a Consultant Ophthalmologist at the Birmingham Midland Eye Centre, Birmingham, UK. Jonathan Martin is a fourth-year medical student at the University of Bristol. The authors report no financial disclosures related to any product or technology mentioned in this article.

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