{Reference Type}: Journal Article
{Title}: Long-term Outcomes of Bowman's Membrane Relaxation for Enhancement of Femtosecond Intrastromal Lenticule Implantation Performed for the Management of High Hyperopia.
{Author}: Brar S;Ganesh S;Sriganesh SS;Dorennavar L;
{Journal}: J Refract Surg
{Volume}: 38
{Issue}: 2
{Year}: Feb 2022
{Factor}: 3.255
{DOI}: 10.3928/1081597X-20211215-01
{Abstract}: <B>OBJECTIVE: </B>To evaluate the feasibility and report long-term outcomes with Bowman's membrane relaxation (BMR) for enhancing the residual refractive error following femtosecond intrastromal lenticule implantation (FILI).<BR><B>METHODS: </B>BMR was performed using a Hessburg-Barron trephine to create a circular incision into the Bowman's membrane and anterior corneal fibers up to the depth of approximately 120 to 130 µm. After enhancement, clinical outcomes were analyzed for a mean period of 36 months (range: 14 to 57 months).<BR><B>RESULTS: </B>Four eyes of 3 patients (mean age: 29 years) underwent enhancement with BMR for a significant residual refractive error of +2.25 diopters (D) spherical equivalent following FILI for high hyperopia (mean spherical equivalent: +7.00 D). After BMR, the residual refraction reduced to +0.31 D, resulting in improvement in uncorrected distance visual acuity from 0.55 to 0.33 logMAR. The mean front keratometry values increased from 46.20 to 49.30 D, and the mean back keratometry values increased from -5.90 to -6.30 D following BMR, the latter returning to the baseline (pre-FILI) value of -6.30 D. An increase in Q-value with a corresponding increase in higher order aberrations was observed. Corneal biomechanics indicated reduction of stiffness and other parameters after enhancement. No intraoperative or postoperative complications were noted.<BR><B>CONCLUSIONS: </B>BMR may be an effective technique for enhancement of residual hyperopia following tissue addition techniques such as FILI. BMR may reverse the posterior curvature changes, negating the steepening effect of the anterior cornea following tissue addition, potentially aiding in the enhancement. [J Refract Surg. 2022;38(2):134-141.].