{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T18:46:53Z","timestamp":1790880413042,"version":"4.1.0"},"reference-count":27,"publisher":"Springer Science and Business Media LLC","issue":"7","license":[{"start":{"date-parts":[[2023,1,21]],"date-time":"2023-01-21T00:00:00Z","timestamp":1674259200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2023,1,21]],"date-time":"2023-01-21T00:00:00Z","timestamp":1674259200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Universit\u00e4tsklinikum Ulm"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Graefes Arch Clin Exp Ophthalmol"],"published-print":{"date-parts":[[2023,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Purpose<\/jats:title>\n                <jats:p>The following is a comparative analysis on the treatment outcomes of corneal perforations using amniotic membrane transplantation (AMT) or penetrating keratoplasty (PK).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>This monocentric retrospective study was performed at the Department of Ophthalmology, University Hospital Ulm, Germany. A total of 78 eyes of 78 patients were included. Thirty-nine eyes received an AMT, and 39 patients were treated with a PK. Primary outcome was recurrence of perforation. Secondary outcomes were patient mortality and visual acuity.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>No statistically significant difference was observed with regard to a recurrence of perforation between the two groups (26% in AMT vs 23% in PK, <jats:italic>p<\/jats:italic>\u2009&gt;\u20090.99). The time of recurrences was within the first two years and did not differ statistically (<jats:italic>p<\/jats:italic>\u2009=\u20090.97). In addition, a proportional hazards model with cox regression regarding recurrent perforation showed no significant differences (<jats:italic>p<\/jats:italic>\u2009=\u20090.5). After AMT, 41% and after KP, 28% of the patients\u00a0died during follow-up (<jats:italic>p<\/jats:italic>\u2009=\u20090.2), respectively. The Charlson Comorbidity Index (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.0001) and the age at the time of surgery (<jats:italic>p<\/jats:italic>\u2009=\u20090.0002) were statistically significantly higher in those who were deceased. A mean follow-up of 485\u2009\u00b1\u2009517\u00a0days was recorded.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>Both surgical methods show good results and no statistically significant difference regarding recurrent perforation rate. About a third of the patients died during the follow-up period. The decision regarding the appropriate method should therefore be based on a combination of all factors.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00417-022-05914-0","type":"journal-article","created":{"date-parts":[[2023,1,21]],"date-time":"2023-01-21T07:02:40Z","timestamp":1674284560000},"page":"1933-1940","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Recurrence of perforation and overall patient survival after penetrating keratoplasty versus amniotic membrane transplantation in corneal perforation"],"prefix":"10.1007","volume":"261","author":[{"given":"Carolin","family":"Elhardt","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Romina","family":"Schweikert","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rupert","family":"Kamnig","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Efstathios","family":"Vounotrypidis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Armin","family":"Wolf","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7017-7560","authenticated-orcid":false,"given":"Christian M.","family":"Wertheimer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2023,1,21]]},"reference":[{"key":"5914_CR1","doi-asserted-by":"publisher","first-page":"166","DOI":"10.22336\/rjo.2019.25","volume":"63","author":"A-C Stamate","year":"2019","unstructured":"Stamate A-C, T\u0103taru CP, Zemba M (2019) Update on surgical management of corneal ulceration and perforation. Romanian J Ophthalmol 63:166","journal-title":"Romanian J Ophthalmol"},{"key":"5914_CR2","doi-asserted-by":"publisher","first-page":"7","DOI":"10.4103\/ijo.IJO_1151_19","volume":"68","author":"R Deshmukh","year":"2020","unstructured":"Deshmukh R, Stevenson LJ, Vajpayee R (2020) Management of corneal perforations: An update. Indian J Ophthalmol 68:7","journal-title":"Indian J Ophthalmol"},{"key":"5914_CR3","doi-asserted-by":"publisher","first-page":"522","DOI":"10.1016\/j.survophthal.2011.06.003","volume":"56","author":"V Jhanji","year":"2011","unstructured":"Jhanji V, Young AL, Mehta JS et al (2011) Management of corneal perforation. Surv Ophthalmol 56:522\u2013538","journal-title":"Surv Ophthalmol"},{"key":"5914_CR4","doi-asserted-by":"publisher","unstructured":"Krysik K, Dobrowolski D, Wylegala E, et al. Amniotic Membrane as a Main Component in Treatments Supporting Healing and Patch Grafts in Corneal Melting and Perforations. J Ophthalmol 2020; 2020: 4238919. 2020\/03\/10.\u00a0https:\/\/doi.org\/10.1155\/2020\/4238919.","DOI":"10.1155\/2020\/4238919"},{"key":"5914_CR5","doi-asserted-by":"publisher","first-page":"368","DOI":"10.1007\/s10384-004-0083-x","volume":"48","author":"AB Nur\u00f6zler","year":"2004","unstructured":"Nur\u00f6zler AB, Salvarli S, Budak K et al (2004) Results of therapeutic penetrating keratoplasty. Jpn J Ophthalmol 48:368\u2013371","journal-title":"Jpn J Ophthalmol"},{"key":"5914_CR6","doi-asserted-by":"publisher","first-page":"303","DOI":"10.1016\/S0002-9394(14)70125-4","volume":"123","author":"S-H Lee","year":"1997","unstructured":"Lee S-H, Tseng SC (1997) Amniotic membrane transplantation for persistent epithelial defects with ulceration. Am J Ophthalmol 123:303\u2013312","journal-title":"Am J Ophthalmol"},{"key":"5914_CR7","doi-asserted-by":"publisher","first-page":"193","DOI":"10.1007\/s10561-017-9618-5","volume":"18","author":"K Jirsova","year":"2017","unstructured":"Jirsova K, Jones GL (2017) Amniotic membrane in ophthalmology: properties, preparation, storage and indications for grafting\u2014a review. Cell Tissue Banking 18:193\u2013204","journal-title":"Cell Tissue Banking"},{"key":"5914_CR8","doi-asserted-by":"publisher","first-page":"224","DOI":"10.1016\/S0301-2115(00)00345-6","volume":"94","author":"N Kjaergaard","year":"2001","unstructured":"Kjaergaard N, Hein M, Hyttel L et al (2001) Antibacterial properties of human amnion and chorion in vitro. Eur J Obstet Gynecol Reprod Biol 94:224\u2013229","journal-title":"Eur J Obstet Gynecol Reprod Biol"},{"key":"5914_CR9","doi-asserted-by":"publisher","first-page":"671","DOI":"10.1038\/nmeth.2089","volume":"9","author":"CA Schneider","year":"2012","unstructured":"Schneider CA, Rasband WS, Eliceiri KW (2012) NIH Image to ImageJ: 25 years of image analysis. Nat Methods 9:671\u2013675","journal-title":"Nat Methods"},{"key":"5914_CR10","doi-asserted-by":"publisher","first-page":"373","DOI":"10.1016\/0021-9681(87)90171-8","volume":"40","author":"ME Charlson","year":"1987","unstructured":"Charlson ME, Pompei P, Ales KL et al (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373\u2013383. https:\/\/doi.org\/10.1016\/0021-9681(87)90171-8","journal-title":"J Chronic Dis"},{"key":"5914_CR11","doi-asserted-by":"publisher","first-page":"676","DOI":"10.1093\/aje\/kwq433","volume":"173","author":"H Quan","year":"2011","unstructured":"Quan H, Li B, Couris CM et al (2011) Updating and validating the Charlson comorbidity index and score for risk adjustment in hospital discharge abstracts using data from 6 countries. Am J Epidemiol 173:676\u2013682","journal-title":"Am J Epidemiol"},{"key":"5914_CR12","doi-asserted-by":"publisher","first-page":"156","DOI":"10.1097\/ICO.0b013e31815b82f2","volume":"27","author":"K Hanada","year":"2008","unstructured":"Hanada K, Igarashi S, Muramatsu O et al (2008) Therapeutic keratoplasty for corneal perforation: clinical results and complications. Cornea 27:156\u2013160. https:\/\/doi.org\/10.1097\/ICO.0b013e31815b82f2","journal-title":"Cornea"},{"key":"5914_CR13","doi-asserted-by":"publisher","first-page":"55","DOI":"10.4274\/tjo.galenos.2018.06937","volume":"49","author":"C Dogan","year":"2019","unstructured":"Dogan C, Arslan OS (2019) Outcomes of Therapeutic and Tectonic Penetrating Keratoplasty in Eyes with Perforated Infectious Corneal Ulcer. Turk J Ophthalmol 49:55\u201360. https:\/\/doi.org\/10.4274\/tjo.galenos.2018.06937","journal-title":"Turk J Ophthalmol"},{"key":"5914_CR14","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1097\/ico.0000000000002044","volume":"39","author":"S Chatterjee","year":"2020","unstructured":"Chatterjee S, Agrawal D (2020) Recurrence of Infection in Corneal Grafts After Therapeutic Penetrating Keratoplasty for Microbial Keratitis. Cornea 39:39\u201344. https:\/\/doi.org\/10.1097\/ico.0000000000002044","journal-title":"Cornea"},{"key":"5914_CR15","doi-asserted-by":"publisher","unstructured":"Fan J, Wang M and Zhong F (2016) Improvement of Amniotic Membrane Method for the Treatment of Corneal Perforation. BioMed research international 2016: 1693815. 2016\/06\/18.\u00a0https:\/\/doi.org\/10.1155\/2016\/1693815.","DOI":"10.1155\/2016\/1693815"},{"key":"5914_CR16","doi-asserted-by":"publisher","first-page":"193","DOI":"10.1007\/s10792-014-9931-y","volume":"35","author":"Z Yalniz-Akkaya","year":"2015","unstructured":"Yalniz-Akkaya Z, Burcu A, Do\u011fan E et al (2015) Therapeutic penetrating keratoplasty for infectious and non-infectious corneal ulcers. Int Ophthalmol 35:193\u2013200. https:\/\/doi.org\/10.1007\/s10792-014-9931-y","journal-title":"Int Ophthalmol"},{"key":"5914_CR17","doi-asserted-by":"publisher","first-page":"481","DOI":"10.1023\/a:1017995810755","volume":"21","author":"SC Tseng","year":"2001","unstructured":"Tseng SC (2001) Amniotic membrane transplantation for ocular surface reconstruction. Biosci Rep 21:481\u2013489. https:\/\/doi.org\/10.1023\/a:1017995810755","journal-title":"Biosci Rep"},{"key":"5914_CR18","doi-asserted-by":"publisher","unstructured":"Rush SW and Rush RB 2016 Outcomes of Infectious versus Sterile Perforated Corneal Ulcers after Therapeutic Penetrating Keratoplasty in the United States. J Ophthalmol 2016: 6284595. 2017\/01\/11.\u00a0https:\/\/doi.org\/10.1155\/2016\/6284595.","DOI":"10.1155\/2016\/6284595"},{"key":"5914_CR19","doi-asserted-by":"publisher","first-page":"434","DOI":"10.1111\/ceo.13709","volume":"48","author":"S Ogra","year":"2020","unstructured":"Ogra S, Sims JL, McGhee CNJ et al (2020) Ocular complications and mortality in peripheral ulcerative keratitis and necrotising scleritis: The role of systemic immunosuppression. Clin Exp Ophthalmol 48:434\u2013441. https:\/\/doi.org\/10.1111\/ceo.13709","journal-title":"Clin Exp Ophthalmol"},{"key":"5914_CR20","doi-asserted-by":"publisher","first-page":"179","DOI":"10.2147\/opth.S80411","volume":"10","author":"S Palioura","year":"2016","unstructured":"Palioura S, Henry CR, Amescua G et al (2016) Role of steroids in the treatment of bacterial keratitis. Clin Ophthalmol (Auckland, NZ) 10:179\u2013186. https:\/\/doi.org\/10.2147\/opth.S80411","journal-title":"Clin Ophthalmol (Auckland, NZ)"},{"key":"5914_CR21","doi-asserted-by":"publisher","first-page":"70","DOI":"10.1097\/icl.0000000000000590","volume":"46","author":"TD Oostra","year":"2020","unstructured":"Oostra TD, Mauger TF (2020) Conjunctival Flaps: A Case Series and Review of the Literature. Eye Contact lens 46:70\u201373. https:\/\/doi.org\/10.1097\/icl.0000000000000590","journal-title":"Eye Contact lens"},{"key":"5914_CR22","doi-asserted-by":"publisher","unstructured":"Roberts HW, Gunasekera CD, Law EM, et al. Sutureless Tectonic Mini-Descemet's Stripping Automated Endothelial Keratoplasty (\"mini-DSAEK\") for the management of corneal perforations. Eur J Ophthalmol 2021: 11206721211050034. 2021\/10\/19.\u00a0https:\/\/doi.org\/10.1177\/11206721211050034.","DOI":"10.1177\/11206721211050034"},{"key":"5914_CR23","doi-asserted-by":"publisher","first-page":"689","DOI":"10.1007\/s10792-019-01229-y","volume":"40","author":"H Yang","year":"2020","unstructured":"Yang H, Zhou Y, Zhao H et al (2020) Application of the SMILE-derived lenticule in therapeutic keratoplasty. Int Ophthalmol 40:689\u2013695. https:\/\/doi.org\/10.1007\/s10792-019-01229-y","journal-title":"Int Ophthalmol"},{"key":"5914_CR24","doi-asserted-by":"publisher","first-page":"3549","DOI":"10.2147\/opth.S324390","volume":"15","author":"HT Nguyen","year":"2021","unstructured":"Nguyen HT, Pham ND, Mai TQ et al (2021) Tectonic Deep Anterior Lamellar Keratoplasty to Treat Corneal Perforation and Descemetocele from Microbial Keratitis. Clin Ophthalmol (Auckland, NZ) 15:3549\u20133555. https:\/\/doi.org\/10.2147\/opth.S324390","journal-title":"Clin Ophthalmol (Auckland, NZ)"},{"key":"5914_CR25","doi-asserted-by":"publisher","first-page":"419","DOI":"10.1111\/vop.12871","volume":"24","author":"EN Rodriguez","year":"2021","unstructured":"Rodriguez EN, Townsend WM, Stiles J (2021) Double drape tectonic patch with cyanoacrylate glue for surgical repair of corneal defects: 8 cases. Vet Ophthalmol 24:419\u2013424. https:\/\/doi.org\/10.1111\/vop.12871","journal-title":"Vet Ophthalmol"},{"key":"5914_CR26","doi-asserted-by":"publisher","first-page":"951","DOI":"10.1097\/ico.0000000000001955","volume":"38","author":"N Sharma","year":"2019","unstructured":"Sharma N, Singhal D, Maharana PK et al (2019) Tuck-In Tenon Patch Graft in Corneal Perforation. Cornea 38:951\u2013954. https:\/\/doi.org\/10.1097\/ico.0000000000001955","journal-title":"Cornea"},{"key":"5914_CR27","doi-asserted-by":"publisher","first-page":"330","DOI":"10.1159\/000508816","volume":"11","author":"L Muceniece","year":"2020","unstructured":"Muceniece L, Markevica I, Laganovska G (2020) Corneal Perforation Self-Healing with an Iris Plug in the Cornea. Case Rep Ophthalmol 11:330\u2013335. https:\/\/doi.org\/10.1159\/000508816","journal-title":"Case Rep Ophthalmol"}],"container-title":["Graefe's Archive for Clinical and Experimental Ophthalmology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00417-022-05914-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00417-022-05914-0\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00417-022-05914-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,6,15]],"date-time":"2023-06-15T10:05:29Z","timestamp":1686823529000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00417-022-05914-0"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1,21]]},"references-count":27,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2023,7]]}},"alternative-id":["5914"],"URL":"https:\/\/doi.org\/10.1007\/s00417-022-05914-0","relation":{},"ISSN":["0721-832X","1435-702X"],"issn-type":[{"value":"0721-832X","type":"print"},{"value":"1435-702X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,1,21]]},"assertion":[{"value":"1 July 2022","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"21 October 2022","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"15 November 2022","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"21 January 2023","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Ulm University (ethical approval id: 178\/21).","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval"}},{"value":"The authors have no competing interests to declare that are relevant to the content of this article.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}]}}