Acellular Bowman Layer and Descemet Membrane Allografts for Non-Ectatic Anterior Corneal Diseases: A Narrative Review of Emerging Evidence
4 affiliations
- 1Hoopes Moshirfar Vision Research Center, Hoopes Vision
- 2Department of Ophthalmology, University of South Carolina School of Medicine
- 3John A. Moran Eye Center, University of Utah School of Medicine
- 4Virginia Eye Consultants
Abstract
Penetrating keratoplasty has long been the standard treatment for many corneal pathologies, but interest has grown in less invasive, tissue-sparing alternatives. Bowman’s layer (BL) and Descemet’s membrane (DM) transplantation are two anterior approaches that use isolated acellular corneal layers to restore structural support and promote epithelial healing, while avoiding many of the limitations of full-thickness grafting. Although both techniques have been described for ectatic disorders, their theoretically low immunogenicity, minimal long-term steroid requirements, and capacity to support reepithelialization make them appropriate options for a range of nonectatic indications. This narrative review describes the application of BL (11 studies) and DM (3 studies) allografts for nonectatic corneal disease, including their surgical techniques, clinical outcomes, and complications. BL allograft studies consisted of 9 case reports (1−3 cases each) and two cohort studies (22 cases and 30 cases), while DM allograft studies included 2 case reports (1 case each) and one large cohort study (99 cases). Across the reviewed literature, both procedures appeared to be associated with complete reepithelialization for the majority of patients, clinically meaningful improvements in visual acuity in patients without visual comorbidities, and few significant complications. Decellularized BL and DM allograft transplantation represent valuable additions to the growing collection of minimally invasive, tissue-sparing approaches for anterior corneal disease, and continued study is warranted to better define their respective roles for nonectatic indications.
Related
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BibTeX
@article{pawlowski2026acellular,
title = {{Acellular Bowman Layer and Descemet Membrane Allografts for Non-Ectatic Anterior Corneal Diseases: A Narrative Review of Emerging Evidence}},
author = {Hanna Pawlowski and Sanjana Molleti and W. Garrett Hayes and Nadim S. Azar and Albert Y. Cheung and Phillip C. Hoopes and Majid Moshirfar},
journal = {Ophthalmology and Therapy},
year = {2026},
month = sep,
doi = {10.1007/s40123-026-01465-3},
url = {https://doi.org/10.1007/s40123-026-01465-3},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Acellular Bowman Layer and Descemet Membrane Allografts for Non-Ectatic Anterior Corneal Diseases: A Narrative Review of Emerging Evidence
AU - Hanna Pawlowski
AU - Sanjana Molleti
AU - W. Garrett Hayes
AU - Nadim S. Azar
AU - Albert Y. Cheung
AU - Phillip C. Hoopes
AU - Majid Moshirfar
PY - 2026
DA - 2026/09/01
JO - Ophthalmology and Therapy
DO - 10.1007/s40123-026-01465-3
UR - https://doi.org/10.1007/s40123-026-01465-3
AB - Penetrating keratoplasty has long been the standard treatment for many corneal pathologies, but interest has grown in less invasive, tissue-sparing alternatives. Bowman’s layer (BL) and Descemet’s membrane (DM) transplantation are two anterior approaches that use isolated acellular corneal layers to restore structural support and promote epithelial healing, while avoiding many of the limitations of full-thickness grafting. Although both techniques have been described for ectatic disorders, their theoretically low immunogenicity, minimal long-term steroid requirements, and capacity to support reepithelialization make them appropriate options for a range of nonectatic indications. This narrative review describes the application of BL (11 studies) and DM (3 studies) allografts for nonectatic corneal disease, including their surgical techniques, clinical outcomes, and complications. BL allograft studies consisted of 9 case reports (1−3 cases each) and two cohort studies (22 cases and 30 cases), while DM allograft studies included 2 case reports (1 case each) and one large cohort study (99 cases). Across the reviewed literature, both procedures appeared to be associated with complete reepithelialization for the majority of patients, clinically meaningful improvements in visual acuity in patients without visual comorbidities, and few significant complications. Decellularized BL and DM allograft transplantation represent valuable additions to the growing collection of minimally invasive, tissue-sparing approaches for anterior corneal disease, and continued study is warranted to better define their respective roles for nonectatic indications.
SN - 2193-8245
SN - 2193-6528
ER -