Intrastromal graft of anterior lens capsule. A substitute for Bowman layer graft transplantation for keratoconus

Abstract Purpose The shortage of donor corneas limits Bowman layer transplantation for keratoconus. In this study, we evaluate the clinical outcome of anterior lens capsule xenograft transplantation in the corneal stroma of a rabbit model as substitute for Bowman layer graft that is used in stromal transplantation for advanced keratoconus. Methods Transplantation of an anterior lens capsule in the corneal stroma was performed in four New Zealand white rabbits through the creation of a stromal pocket. Corneal transparency, central corneal thickness, and topographic characteristics of corneas were evaluated at different time points: pre- (0) and post- (7, 14, 21, and 28) operative days. Additionally, at the end of the study histopathological findings were evaluated. Results In comparison to pre-operative day, transplantation of an anterior lens capsule preserved corneal transparency, central corneal thickness, and topographic characteristics remained constant throughout the study period. Histopathological analysis revealed the presence of the anterior lens capsule as a fully integrated lamellar graft without adverse effects in host stroma. Conclusion The anterior lens capsule may be useful as a graft for intrastromal corneal trasplantation. Similarly to Bowman layer, anterior lens capsule has mechanical characteristics that facilitate corneal transplantation. In post-transplanted corneas the preservation of transparency, as well as the effect on corneal thickness, and topographic characteristics support the possibility of using anterior lens capsule as a substitute for Bowman layer graft.