The 2014 Bowman Lecture—Bowman’s and Bruch’s: a tale of two membranes during the laser revolution

Marshall, John

doi:10.1038/eye.2014.240

Cited by 21 publications

(14 citation statements)

References 69 publications

(60 reference statements)

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“…This is associated with a decreased capacity for exchange of macromolecules, membranous debris and fluids between the RPE and choroid (Hussain et al. ; Marshall ).…”

Section: Pathogenetic Features Of Amdmentioning

confidence: 99%

Drusen maculopathy: a risk factor for visual deterioration

Algvere

Kvanta

Seregard

2016

Acta Ophthalmologica

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Age-related macular degeneration (AMD), the most common cause of visual loss after the age of 65, displays a degeneration of the retinal pigment epithelial (RPE) cells and photoreceptors in the retinal centre (macula). The central macula (fovea) that contains mostly cone photoreceptors mediates the high visual acuity. Drusen maculopathy may lead to visual deterioration. Drusen are extracellular deposits of debris that accumulate on Bruch 0 s membrane. Drusen attract inflammatory, immunological and vasoactive stimuli. RPE and pho-toreceptor cells overlying drusen exhibit biochemical and morphological signs of degeneration. Strong and intermittent light exposure (photons) induces the formation of free radicals in the very high oxygen tension milieu of the retina. The negative effects of irradiation stimulate accumulation of lipofuscin in RPE and photoreceptor cells leading to mitochondrial dysfunction and apoptotic cell death. A hydrophobic barrier is built up in Bruch 0 s membrane reducing diffusion to the choroid. Hereditary and inflammatory factors modify the risk for AMD. There is a genetic dysregulation of the complement system leading to inappropriate complement activation. The genetic polymorphism of complement factor H (CFH) and age-related maculopathy susceptibilty 2 (ARMS2) increase the risk of progression to advanced AMD. The photoelectric effect creates free radicals, resulting in a continuous increase of lipofuscin formation and impairing mitochondrial activity. In addition, inflammation and complement dysregulation contribute to the formation of drusen and vasoproliferative reactions with neovascularization. Antioxidants neutralize reactive oxygen species and reduce lipofuscin accumulation in RPE and photoreceptor cells. For prophylactic treatment of drusen maculopathy, high doses of antioxidants such as vitamins C and E, lutein, zeaxanthine and zinc are used according to the Age-Related Eye Disease Study 2 (AREDS 2). The risk of developing advanced AMD was reduced by 27% at 10 years follow-up. No adverse events were noted.

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“…This is associated with a decreased capacity for exchange of macromolecules, membranous debris and fluids between the RPE and choroid (Hussain et al. ; Marshall ).…”

Section: Pathogenetic Features Of Amdmentioning

confidence: 99%

Drusen maculopathy: a risk factor for visual deterioration

Algvere

Kvanta

Seregard

2016

Acta Ophthalmologica

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“…In keratoconus, it has been observed that these breaks result in fragmentation of the Bowman's layer that then get filled by stromal collagen (Sherwin and Brookes, ). Although the layer's exact role is uncertain, it has been suggested that the Bowman's layer is a strong biomechanical component (Marshall, ). The common breaks in Bowman's layer seen in keratoconic corneas may therefore be responsible for the eye‐conic change in shape.…”

Section: Keratoconusmentioning

confidence: 99%

Keratoconus at a Molecular Level: A Review

Volatier

Figueiredo

Connon

2019

The Anatomical Record

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Keratoconus is the most common ectatic disease of the cornea. The disease is usually detected between ages 15 and 25. Incidence is estimated at one out of every 2000 individuals, with some specific ethnic groups being more at risk. Keratoconus manifests itself as a progressive stromal thinning and deformation of the corneal tissue into a conical shape. The etiology of keratoconus is uncertain, although several studies have associated the disease to environmental factors, behavioral conditions and certain genetic disorders. In an effort to better understand how the corneal stroma becomes compromised, multiple experiments have been conducted over the last few years looking at the cells themselves and the factors they produce. The secretion pathways and levels of inflammatory molecules, growth factors, digestive enzymes, and apoptotic factors are all relevant to keratoconus. This review describes the current knowledge of keratoconic pathological signaling pathways within the cornea that may help future developments in disease prevention, treatment and modeling.

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“…Lie et al performed the first BL transplantation surgery in 2010 to eliminate and prevent the recurrence of subepithelial haze after PRK [ 8 ]. BL might increase corneal biomechanism too, and it has been suggested that the BL may be the strongest biomechanical part of the human cornea [ 9 ]. BL transplantation allows patients to maintain acceptable visual acuity with glasses or contact lenses and may postpone or prevent the need for penetrating keratoplasty (PK) or deep anterior lamellar keratoplasty (DALK) [ 10 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

Establishing a Porcine Eye Model for Manual Sub-Bowman Layer Photorefractive Keratomileusis

Tian

et al. 2020

Journal of Ophthalmology

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Objective. To establish a porcine eye model for manual sub-Bowman layer photorefractive keratomileusis (SBPRK), which is a reformed surface ablation refractive surgery that results in preserving the corneal Bowman layer (BL). Methods. The SBPRK group consisted of eleven eyes of 8 healthy pigs with BL flaps by mechanical technique followed by laser ablation. Regarding the remaining 5 eyes, 3 random eyes had transepithelium photorefractive keratectomy (TransPRK) (the TransPRK group), while the other 2 eyes were untreated (the blank control group). All the pigs were followed up for 8 weeks. Slit-lamp biomicroscopy and optical coherence tomography (OCT) were examined before the surgeries and at 1 week, 4 weeks, and 8 weeks after the surgeries. Results. In a few days after the surgery, 3 eyes of the SBPRK group were excluded from the study because of poor healing of the corneal flaps. At the 1st postoperative week, one eye had an irregular defect of about 3 mm in the central corneal epithelium area; the cornea of the other 7 eyes had just light edema with intact epithelium just like the cornea of the TransPRK group. At the 4th week, in the SBPRK group, the cornea was slightly hazy (haze stage 1). While in the TransPRK group, the cornea was hazier (haze stage 2). At the 8th week, in the SBPRK group, both corneas were almost transparent, and the edges of the BL flaps could not be clearly seen. Meanwhile, in the TransPRK group, the corneal haze became lighter and thinner. OCT showed that, in the SBPRK group, there was high reflection in the BL layer, and it was obvious at 1 week postoperation, decreased at 4 weeks, and calmed down at 8 weeks. However, in the TransPRK group, the high reflection diffused in the anterior corneal stroma at 1 week postoperation, enhanced at 4 weeks, and weakened at 8 weeks. Conclusions. Preserving the BL while conducting surface refractive surgery may result in less haze than TransPRK. However, further study is still needed, and this technique still requires refining until it becomes a standard clinical procedure.

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The 2014 Bowman Lecture—Bowman’s and Bruch’s: a tale of two membranes during the laser revolution

Cited by 21 publications

References 69 publications

Drusen maculopathy: a risk factor for visual deterioration

Drusen maculopathy: a risk factor for visual deterioration

Keratoconus at a Molecular Level: A Review

Establishing a Porcine Eye Model for Manual Sub-Bowman Layer Photorefractive Keratomileusis

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