Corneal Collagen Cross-Linking Mushroom Shape Demarcation Line Profile After Limited Bowman’s Membrane Removal by Phototherapeutic Keratectomy

George D Kymionis*, 1, 2, Michael A Grentzelos 1, Nektarios E Klados 1, Niki A Xanthopoulou 1, Theodore A Paraskevopoulos 1, Efstathios T Detorakis1
1 Vardinoyiannion Eye Institute of Crete (VEIC), Faculty of Medicine, University of Crete, Heraklion, Crete, Greece
2 Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, FL, USA

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© Kymionis et al.; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the University of Crete, Faculty of Medicine, Institute of Vision and Optics (IVO), 71003 Heraklion, Crete, Greece; Tel: +302810371800; Fax: +302810394653; E-mail:


Purpose :

To report a corneal collagen cross-linking (CXL) mushroom shape demarcation line profile after limited Bowman’s membrane removal by phototherapeutic keratectomy (PTK).

Methods :

Case report.

Results :

A twenty-one-year-old male with progressive keratoconus underwent mechanical epithelial debridement (at an 8.5 mm zone) followed by PTK (at a 5.0 mm zone and in a 10 μm depth) and CXL. No intra- or early postoperative complications were found. Evaluation of the corneal stromal demarcation line depth using anterior segment optical coherence tomography revealed a mushroom shape profile.

Conclusion :

It seems that removal of the Bowman’s layer leads to greater depth of the corneal stromal demarcation line.

Keywords: Cross-linking, keratoconus, phototherapeutic keratectomy..