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The patient rubbed her eyes and did not tolerate contact lenses. Following standard technique, a 8mm Bowman layer graft was placed into a intrastromal pocket with no intraoperative complications. Results: Postoperatively, the patient remained stable and topography showed notable central flattening but 17 days after the BTL was performed she developed a sterile corneal necrosis. Conclusions: Many studies have proven the efficacy of this technique as a potential treatment for stabilizing progressive and advanced keratoconus in selected cases. Few complications associated with BTL have been reported, including Bowman Layer tears or buttonholes when obtaining the tissue, very thick grafts or postoperative hydrops but no sterile necrosis described to the date. A combination of the hypotheses raised in this paper may explain this undesirable event.<\/jats:p>","DOI":"10.1177\/11206721231165438","type":"journal-article","created":{"date-parts":[[2023,3,22]],"date-time":"2023-03-22T02:42:21Z","timestamp":1679452941000},"page":"1558-1566","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":2,"title":["Sterile corneal necrosis after bowman layer transplantation"],"prefix":"10.1177","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0335-4301","authenticated-orcid":false,"given":"Ana","family":"Orive Ba\u00f1uelos","sequence":"first","affiliation":[{"name":"Department of Ophthalmology, BioCruces Bizkaia Health Research Institute, University Hospital of Cruces, Barakaldo, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alaitz","family":"Santamar\u00eda Carro","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, BioCruces 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