MI. Lema Gesto

Profesora Titular de Oftalmología, Facultad de Medicina y Facultad de Óptica y Optometría. Universidad de Santiago de Compostela.
Laboratorio de Investigación en Neurociencias Clínicas (LINC). Instituto de Investigación Sanitaria (IDIS). Santiago de Compostela.
Instituto Galego de Oftalmoloxía (INGO). Complexo Hospitalario Clínico Universitario. Santiago de Compostela.

M.ª Isabel Lema Gesto
E-mail: mariaisabel.lema@usc.es

Bowman layer transplantation since its introduction in 2014, has come to stay in the range of therapeutic alternatives to treat keratoconus patients. Main indication is in keratoconus that are not candidates neither for cross-linking nor for intrastromal rings and where keratoplasty of any type, wether deep anterior keratoplasty (DALK) or penetrating keratoplasty (PK), are not the choice for any reason. Main goal of this technique is to stabilize the cornea halting keratoconus progression and at the same time reshape the cornea flattening it. The surgical technique is not much difficult what makes the learning curve short. Moreover it’s got a low rate of surgical risks rather than other techniques such as DALK which has a high rate of reconversion into PK. The surgical technique entails to perform an intrastromal pocket in the receptor cornea approximately 50% deep. Then Bowman layer, previously obtained through dissection of the donor cornea, is introduced inside the pocket. Bowman layer can also be used as an onlay in cases of intense subepithelial haze. Postoperative results are favourable with notable reductions in keratometry in some cases, and with later adaptation of a hard or scleral contact lens visual acuity can reach acceptable levels.

La utilitat més important d’un biomarcador és per al diagnòstic precoç. Per això és necessari conèixer el perfil d’expressió proteic en condicions fisiològiques i patològiques. Els millors biomarcadors són les proteïnes: poden detectar una malaltia, l’activitat, el pronòstic i la resposta terapèutica. Al queratocono es poden determinar biomarcadors en llàgrima, en cèl•lules sanguínies i en cèl•lules epitelials corneals i conjuntivals. La conjunció de tots ells és determinant per conèixer la fisiopatologia de la èctasi i resulta de gran ajuda per al diagnòstic precoç i el seguiment de la malaltia.

The most important utility of a biomarker is for early diagnosis. For this it is necessary to know the protein expression profile in physiological and pathological conditions. The best biomarkers are proteins: they can detect disease, activity, prognosis and therapeutic response. In keratoconus, biomarkers can be determined in tears, in blood cells and in corneal and conjunctival epithelial cells. The combination of all of them is crucial to know the physiopathology of ectasia and a great help for early diagnosis and monitoring of the disease.