Bowman's Membrane Lenticule Tuck-in: A New Approach for the Management of Neurotrophic Ulcers

Purpose: To evaluate a new surgical method for managing nonhealing neurotrophic ulcers using a novel technique of tucking-in Bowman's membrane lenticule in the ulcer defect.

Methods: A total of 22 eyes of 22 patients with neurotrophic ulcers of various etiologies and stages were included and underwent a surgical process where a donor Bowman's membrane lenticule was harvested and fashioned according to the lesion and tucked inside the ulcer after making a recess in anterior one-third of stroma all around 360 degrees. The primary outcomes measured were healing (stable epithelialization at 12 months) and best-corrected visual acuity (BCVA) improvement.

Results: Twenty-two eyes of 22 patients with neurotrophic ulcers underwent Bowman's membrane lenticule tuck-in procedure. Complete re-epithelialization was achieved in 21 eyes (95.45%). The average healing time was 2.77 ± 0.79 weeks. The mean corneal thickness improved from 267.36 ± 94.56 mm preoperatively to 435.9 ± 47.71 mm at six months postoperatively. The mean BCVA also improved from 0.05 ± 0.07 preoperatively to 0.24 ± 0.24 postoperatively one year. One patient (4.54%) showed recurrence after one month, and the epithelial defect persisted till the end of the study.

Conclusion: Donor Bowman's membrane lenticule tuck-in for neurotrophic ulcers is a safe and highly effective treatment and requires minimal instruments and expertise.