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Femtosecond laser-assisted Bowman layer implantation combined with corneal cross-linking (femto Bowman inlay + cross-linking; FBI Xtra): a novel combined technique for advanced progressive keratoconus

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Session Details

Session Title: Surgical Cornea

Session Date/Time: Tuesday 25/09/2018 | 16:30-18:00

Paper Time: 17:12

Venue: Room A3, Podium 3

First Author: : V.Liarakos GREECE

Co Author(s): :    V. Liarakos   K. Giannopoulou   G. Karastatiras   N. Kappos   I. Tzavella   E. Kiskira     

Abstract Details


To evaluate feasibility and efficacy of the use of a Femtosecond Laser for accurate intrastromal implantation of a donor Bowman layer, followed by conventional corneal crosslinking (Femto Bowman Implantation and Crosslinking or FBI Xtra).


(1) Naval and Veterans Hospital, Athens, Greece (2) AKTINA Center, Athens, Greece


The novel combined technique was applied to a keratoconus eye intolerant to contact lenses with a maximum curvature of 92.0D and corneal stromal thickness (at the thinnest point) of 147 microns. A Femtosecond Laser device (Alcon Wavelight FS-200) was programmed to create a planar intrastromal dissection at a precise depth. A donor Bowman layer transplant was inserted inside the stromal pocket using a modified manipulator. Riboflavin 0.1% was irrigated inside the pocket for 30 minutes followed by ultraviolet (UV-A) irradiation (370nm; 3mW/cm2 ) for another 30 minutes. No sutures were used.


The dissection plane was uniform and smooth, at an equal depth. The use of a specific manipulator facilitated the implantation and unfolding of the graft. Direct intrastromal irrigation with riboflavin increased corneal thickness over 400 microns, allowing for UV crosslinking. The patient was able to return to his routine the next day with minor discomfort. Corneal thickness increased symmetrically by an average of 50 microns. Mean curvature was reduce from 70.0D to 66.5D within the first month. Epithelial map was normalized, allowing for contact lens fitting. The cornea remains transparent and stable 12 months after surgery without any complication.


Femto Bowman Implantation combined with Crosslinking (FBI Xtra) is a safe procedure that may achieve precise, uniform and predictable intrastromal implantation of a donor Bowman layer combined with securing the result with UV crosslinking.

Financial Disclosure:


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