Customized Bowman-Stromal Inlay: An Attempt to Change the Topography of the Keratoconus Cornea

The objective of this report is to describe a modification of a previously reported technique with an aim of improving the corneal topography and visual outcomes in progressive keratoconus along with stabilization of ectasia.In a 26-year-old man with progressive keratoconus, corneal collagen cross-linking was performed in one eye. The other eye had a keratometry of 69.6 D and thinnest pachymetry of 397 µm for which a customized Bowman-stromal inlay surgery was performed. The technique involved the harvesting of Bowman-stromal inlay (anterior 180-μm human donor cornea having the Bowman's layer and anterior stroma) using the femtosecond laser and central ablation of this inlay was done on the stromal side using an excimer laser. This customized inlay was placed in the anterior stromal pocket of the patient's cornea using a regular intraocular lens injector.Stabilization of keratoconus could be achieved in the present case along with improvement in the corrected distance visual acuity and pachymetry. Maximum keratometry decreased from 69.6 D to 57.3 D.Customized Bowman-stromal inlay technique appears to be a step towards creating an ideal inlay for the keratoconus cornea.