Bowman layer onlay transplantation in the management of epithelial-stromal dystrophies of Reis — Bücklers and Thiel — Behnke

Epithelial-stromal dystrophies (ESD) are bilateral, genetically determined, progressive corneal diseases, in all cases accompanied by destruction of the Bowman’s layer. The operation of first choice is superficial keratectomy, but the risk of recurrence is always high. Purpose of the work: to evaluate the effectiveness of Bowman’s layer transplantation in the complex treatment of Reis — Bücklers and Thiel — Behnke dystrophies. Material and methods. The study is pilot, limited, prospective, monocentric. Four eyes of three patients aged 32 ± 9 years with primary and recurrent ESD were operated on. The follow-up period was 24 months. The examination included biomicroscopy, visometry, keratanalysis, optical coherence tomography of the cornea. The surgical technique included excimer laser ablation, mitomycin C application and Bowman’s layer transplantation. Complications, best-corrected visual acuity, corneal transparency, and relapse rate were assessed. Results. There were no intraoperative or postoperative complications. No signs of relapse were noted within 24 months, the cornea and transplant remained transparent. The average best-corrected visual acuity increased from 0.1 ± 0.1 to 0.5 ± 0.1, the average central corneal thickness after 24 months was 545 ± 44 μm. Conclusion. Bowman’s layer transplantation in the complex treatment of Reis — Bücklers and Thiel — Behnke dystrophies makes it possible to easily restore the anatomy of the anterior corneal surface after laser ablation and avoid significant corneal thinning. The technique is simple, ensures restoration of corneal transparency and the absence of relapses within the available observation periods, and does not increase the need for donor tissue. For greater objectivity, it is necessary to increase the number of clinical cases and observation periods.

1. Weiss J, Møller H, Aldave A, et al. IC3D classification of corneal dystrophies-edition 2. Cornea. 2015; 34 (2): 117–59. https://doi.org/10.1097/ICO.0000000000000307

2. Reis W. Fämiliare, fleckige Hornhautetartung. Deutsche Medizinische Wochenschrift. 1917; 43: 575.

3. Bücklers M. Über eine weitere familiare Hornhautdystrophie (Reis). Klinische Monatsblätter für Augenheilkunde. 1949; 114: 386–97.

4. Lawin-Brüssel C, Refojo M, Leong F, Kenyon K. Scanning electron microscopy of the early host inflammatory response in experimental Pseudomonas keratitis and contact lens wear. Cornea. 1995; 14 (4): 355–9. https://doi.org/10.1097/00003226-199507000-00002

5. Munier F, Korvatska E, Djemaï A, et al. Kerato-epithelin mutations in four 5q31-linked corneal dystrophies. Nat Genet. 1997; 15 (3): 247–51. https://doi.org/10.1038/ng0397-247

6. Escribano J, Hernando N, Ghosh S, Crabb J, Coca-Prados M. cDNA from human ocular ciliary epithelium homologous to beta ig-h3 is preferentially expressed as an extracellular protein in the corneal epithelium. J Cell Physiology. 1994; 160 (3): 511–21. https://doi.org/10.1002/jcp.1041600314

7. Akhtar S, Meek K, Ridgway A, Bonshek R, Bron A. Deposits and proteoglycan changes in primary and recurrent granular dystrophy of the cornea. Arch Ophthalmology. 1999; 117 (3): 310–21. https://doi.org/10.1001/archopht.117.3.310

8. Spelsberg H, Reinhard T, Henke L, Berschick P, Sundmacher R. Penetrating limbo-keratoplasty for granular and lattice corneal dystrophy: survival of donor limbal stem cells and intermediate-term clinical results. Ophthalmology. 2004; 111 (8): 1528–33. https://doi.org/10.1016/j.ophtha.2004.01.030

9. Choi S, Yoo Y, Kim B, et al. Involvement of TGF-beta receptor and integrin-mediated signaling pathways in the pathogenesis of granular corneal dystrophy II. Invest Ophthalmol Vis Sci. 2010; 51 (4): 1832–47. https://doi.org/10.1167/iovs.09-4149

10. Wood T, Fleming J, Dotson R, Cotten M. Treatment of Reis-Bücklers’ corneal dystrophy by removal of subepithelial fibrous tissue. Am J Ophthalmology. 1978; 85 (3): 360–2. https://doi.org/10.1016/s0002-9394(14)77730-x306753

11. Vinciguerra P, Vinciguerra R, Randleman J, et al. Sequential customized therapeutic keratectomy for Reis-Bücklers’ corneal dystrophy: Long-term follow-up. J Refract Surgery. 2018; 34 (10): 682–8. https://doi.org/10.3928/1081597X-20180829-01

12. Mashima Y, Kawai M, Yamada M. Corneal electrolysis for recurrence of corneal stromal dystrophy after keratoplasty. Br J Ophthalmology. 2002; 86 (3): 273–5. https://doi.org/10.1136/bjo.86.3.273

13. Steger B, Romano V, Biddolph S, et al. Femtosecond Laser-Assisted Lamellar Keratectomy for corneal opacities secondary to anterior corneal dystrophies: An Interventional Case Series. Cornea. 2016; 35 (1): 6–13. https://doi.org/10.1097/ICO.0000000000000665

14. McDonnell P, Seiler T. Phototherapeutic keratectomy with excimer laser for Reis-Bückler’s corneal dystrophy. Refractive Corneal Surgery. 1992 Jul-Aug; 8 (4): 306–10. PMID: 1390411.

15. Ohman L, Fagerholm P. The influence of excimer laser ablation on recurrent corneal erosions: a prospective randomized study. Cornea. 1998; 17 (4): 349–52. https://doi.org/10.1097/00003226-199807000-00001

16. Oganesyan O.G., Getadaryan V.R., Makarov P.V., Grdikanyan A.A. Bowman layer transplantation in eyes with progressive advanced keratoconus. Russian ophthalmological journal. 2019; 12 (4): 43–50 (In Russ.). https://doi.org/10.21516/2072-0076-2019-12-4-43-50

17. Oganesyan O.G., Ashikova P.M., Khandzhyan A.T., et al. Method for obtaining donor transplantat of Bowman’s layer of cornea. Patent RF № 2020118353, 28.01.2021 (In Russ.). https://patenton.ru/patent/RU2741697C1

18. Kornmehl E, Steinert R, Puliafito C. A comparative study of masking fluids for excimer laser phototherapeutic keratectomy. Arch Ophthalmology. 1991; 109 (6): 860–3. https://doi.org/10.1001/archopht.1991.01080060124039

19. Aldave A, Sonmez B, Forstot S, et al. A clinical and histopathologic examination of accelerated TGFBIp deposition after LASIK in combined granular-lattice corneal dystrophy. Am J Ophthalmology. 2007; 143 (3): 416–9. https://doi.org/10.1016/j.ajo.2006.11.056

20. Hieda O, Kawasaki S, Wakimasu K, et al. Clinical outcomes of phototherapeutic keratectomy in eyes with Thiel-Behnke corneal dystrophy. Am J Ophthalmology. 2013; 155 (1): 66–72. https://doi.org/10.1016/j.ajo.2012.06.022

21. Dinh R, Rapuano C, Cohen E, Laibson P. Recurrence of corneal dystrophy after excimer laser phototherapeutic keratectomy. Ophthalmology. 1999; 106 (8): 1490–7. https://doi.org/10.1016/S0161-6420(99)90441-4

22. Rogers C, Cohen P, Lawless M. Phototherapeutic keratectomy for Reis Bücklers’ corneal dystrophy. Aust N Z J Ophthalmology. 1993; 21 (4): 247–50. https://doi.org/10.1111/j.1442-9071.1993.tb00963.x

23. Talamo J, Gollamudi S, Green W, et al. Modulation of corneal wound healing after excimer laser keratomileusis using topical mitomycin C and steroids. Arch Ophthalmology. 1991; 109 (8): 1141–6. https://doi.org/10.1001/archopht.1991.01080080101040

24. Miller A, Solomon R, Bloom A, et al. Prevention of recurrent Reis-Bücklers dystrophy following excimer laser phototherapeutic keratectomy with topical mitomycin C. Cornea. 2004; 23 (7): 732–5. https://doi.org/10.1097/01.ico.0000127476.37175.6d

25. Umeno K, Ito M, Fushimi N, et al. Electrolysis for corneal granular dystrophy. Ganka. 1999; 41: 905–9.

26. Edelstein S, DeMatteo J, Stoeger C, Macsai M, Wang C. Report of the Eye Bank Association of America Medical Review Subcommittee on Adverse Reactions reported from 2007 to 2014. Cornea. 2016; 35 (7): 917–26. https://doi.org/10.1097/ICO.0000000000000869

27. Lyons C, McCartney A, Kirkness C, et al. Granular corneal dystrophy. Visual results and pattern of recurrence after lamellar or penetrating keratoplasty. Ophthalmology. 1994; 101 (11): 1812–7. https://doi.org/10.1016/s0161-6420(94)31096-7

28. Fogla R, Knyazer B. Microkeratome-assisted two-stage technique of superficial anterior lamellar keratoplasty for Reis-Bücklers corneal dystrophy. Cornea. 2014; 33 (10): 1118–22. https://doi.org/10.1097/ICO.0000000000000189

29. Melles G, Binder P, Anderson J. Variation in healing throughout the depth of long-term, unsutured, corneal wounds in human autopsy specimens and monkeys. Arch Ophthalmology. 1994; 112 (1): 100–9. https://doi.org/10.1001/archopht.1994.01090130110027

30. 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 Sci. 2009; 50 (9): 4192–8. https://doi.org/10.1167/iovs.09-378