Contribution of Bowman layer to corneal biomechanics

Purpose: To compare the elastic modulus of thin corneal lamellas using 2D stress-strain extensometry in healthy ex vivo human corneal lamellas with or without the presence of Bowman layer. Setting: Center for Applied Biotechnology and Molecular Medicine, University of Zurich, Switzerland; ELZA Institute, Dietikon, Switzerland; Department of Ophthalmology, Philipps University of Marburg, Germany. Design: Prospective experimental laboratory study. Methods: Healthy human corneas were stripped of Descemet membrane and the endothelium for Descemet membrane endothelial keratoplasty. After epithelium removal, corneas were divided into 2 groups. In Group 1, Bowman layer was ablated with an excimer laser (20 mu m thick, 10 mm). In Group 2, Bowman layer was left intact. Then, a lamella was cut from the anterior cornea with an automated microkeratome. Elastic and viscoelastic material properties were analyzed by 2D stress-strain extensometry between 0.03 and 0.70 N. Results: Twenty-six human corneas were analyzed. The mean lamella thickness was 160 +/- 37 mu m in corneas with Bowman layer and 155 +/- 22 mu m in corneas without. No statistically significant differences between flaps with and without Bowman layer were observed in the tangential elastic modulus between 5% and 20% strain (11.5 +/- 2.9 kPa vs 10.8 +/- 3.7 kPa, P >.278). Conclusions: The presence or absence of Bowman layer did not reveal a measurable difference in corneal stiffness. This may indicate that the removal of Bowman layer during photorefractive keratectomy does not represent a disadvantage to corneal biomechanics. Copyright (C) 2021 Published by Wolters Kluwer on behalf of ASCRS and ESCRS

Automated summary

The presence or absence of Bowman layer did not show a measurable difference in corneal stiffness in healthy ex vivo human corneal lamellas. Therefore, removing Bowman layer during photorefractive keratectomy may not have a negative impact on corneal biomechanics.