{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T22:47:32Z","timestamp":1776725252188,"version":"3.51.2"},"reference-count":47,"publisher":"Georg Thieme Verlag KG","issue":"04","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Klin Monbl Augenheilkd"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Purpose This retrospective study aims to evaluate the clinical outcomes of a customised \u201cbanana-shaped\u201d anterior lamellar keratoplasty technique in the treatment of peripheral corneal ulcerative perforations in six patients treated at a tertiary care center in Switzerland over a one-year period.<\/jats:p>\n                  <jats:p>Methods In this retrospective observational study conducted between December 2023 and December 2024 at a tertiary care center in Switzerland, six patients (5 male, aged 48\u200a\u2013\u200a86 years) with peripheral corneal ulcer perforations underwent a customized crescent-shaped (\u201cbanana-shaped\u201d) anterior lamellar keratoplasty. Three patients had perforations secondary to peripheral ulcerative keratitis (PUK) of autoimmune origin, one patient presented with a perforated neurotrophic corneal ulcer, another patient had a perforation due to surgically induced necrotizing scleritis, and the last patient had a perforation secondary to gonococcal keratoconjunctivitis. The corneal grafts were tailored to the size and location of the peripheral defects while preserving the central cornea. All patients were treated with topical corticosteroids and antibiotics postoperatively, with systemic therapy adjusted to the etiology of the ulceration. Outcomes assessed included graft clarity,\n          epithelial healing, anatomical integrity, and best spectacle corrected visual acuity (BSCVA), with follow-up ranging from 6 to 12 months.<\/jats:p>\n                  <jats:p>Results Anatomical integrity of the globe was successfully restored in all six patients. All grafts remained clear, and epithelial healing was achieved within 10 days to 4 weeks. There were no cases of graft rejection or recurrent inflammation. Final BSCVA ranged from 0.7 to 0.3 logMAR.<\/jats:p>\n                  <jats:p>Conclusion Customised \u201cbanana-shaped\u201d anterior lamellar keratoplasty is a safe and effective surgical approach for the management of peripheral corneal ulcerative perforations, particularly in cases of PUK. This technique allows localised structural repair while preserving the central visual axis, resulting in favorable anatomical and visual outcomes.<\/jats:p>","DOI":"10.1055\/a-2786-0438","type":"journal-article","created":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T22:34:26Z","timestamp":1776724466000},"page":"385-395","source":"Crossref","is-referenced-by-count":0,"title":["One-year Data on Customised Deep Anterior Lamellar Keratoplasty for Peripheral Corneal Perforations at a Tertiary Care Centre in Switzerland"],"prefix":"10.1055","volume":"243","author":[{"given":"Muntadher Al","family":"Karam","sequence":"additional","affiliation":[{"name":"Ophthalmology, University Hospital of Zurich, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2037-4766","authenticated-orcid":false,"given":"Sadiq","family":"Said","sequence":"additional","affiliation":[{"name":"Ophthalmology, University Hospital of Zurich, Switzerland"},{"name":"Augenklinik Wettingen, Wettingen, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zisis","family":"Gatzioufas","sequence":"additional","affiliation":[{"name":"Ophthalmology, University Hospital of Basel, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9804-417X","authenticated-orcid":false,"given":"Timothy","family":"Hamann","sequence":"additional","affiliation":[{"name":"Ophthalmology, University Hospital of Zurich, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sandrine","family":"Zweifel","sequence":"additional","affiliation":[{"name":"Ophthalmology, University Hospital of Zurich, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5431-4991","authenticated-orcid":false,"given":"Daniel","family":"Barthelmes","sequence":"additional","affiliation":[{"name":"Ophthalmology, University Hospital of Zurich, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Frank","family":"Blaser","sequence":"additional","affiliation":[{"name":"Ophthalmology, University Hospital of Zurich, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2026,4,20]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"634","DOI":"10.1136\/BJOPHTHALMOL-2016-308618","article-title":"Non-traumatic corneal perforations: aetiology, treatment and outcomes","volume":"101","author":"D Loya-Garcia","year":"2017","journal-title":"Br J Ophthalmol"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"7","DOI":"10.4103\/IJO.IJO_1151_19","article-title":"Management of corneal perforations: An update","volume":"688","author":"R Deshmukh","year":"2020","journal-title":"Indian J Ophthalmol"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"522","DOI":"10.1016\/j.survophthal.2011.06.003","article-title":"Management of Corneal Perforation","volume":"56","author":"V Jhanji","year":"2011","journal-title":"Surv Ophthalmol"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1016\/j.survophthal.2018.06.002","article-title":"Surgical management of peripheral corneal thinning disorders","volume":"64","author":"M Lohchab","year":"2019","journal-title":"Surv Ophthalmol"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"2165","DOI":"10.2147\/OPTH.S71102","article-title":"Surgical therapies for corneal perforations: 10 years of cases in a tertiary referral hospital","volume":"8","author":"H Yokogawa","year":"2014","journal-title":"Clin Ophthalmol"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"629","DOI":"10.1007\/S00417-021-05389-5","article-title":"Prognosis and etiology of traumatic and non-traumatic corneal perforations in a tertiary referral hospital: a 30-year retrospective study","volume":"260","author":"S Takahashi","year":"2022","journal-title":"Graefes Arch Clin Exp Ophthalmol"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"108458","DOI":"10.1016\/j.exer.2021.108458","article-title":"Biology of peripheral ulcerative keratitis","volume":"204","author":"B F Gomes","year":"2021","journal-title":"Exp Eye Res"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"98","DOI":"10.1016\/j.ajo.2025.01.014","article-title":"Clinical Outcomes in Peripheral Ulcerative Keratitis","volume":"272","author":"K Mallem","year":"2025","journal-title":"Am J Ophthalmol"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"835","DOI":"10.1016\/j.rdc.2007.08.002","article-title":"Scleritis and peripheral ulcerative keratitis","volume":"33","author":"A Galor","year":"2007","journal-title":"Rheum Dis Clin North Am"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"379","DOI":"10.1016\/S0039-6257(98)00051-4","article-title":"Vasculitic peripheral ulcerative keratitis","volume":"43","author":"E M Messmer","year":"1999","journal-title":"Surv Ophthalmol"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"25","DOI":"10.3899\/JRHEUM.190768","article-title":"Ocular Manifestations in Rheumatoid Arthritis, Connective Tissue Disease, and Vasculitis: A Systematic Review and Metaanalysis","volume":"48","author":"M A Turk","year":"2021","journal-title":"J Rheumatol"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"662","DOI":"10.1016\/j.ajo.2007.12.020","article-title":"Primary Diseases of Corneal Perforation in Shandong Province, China: A 10-Year Retrospective Study","volume":"145","author":"L Xie","year":"2008","journal-title":"Am J Ophthalmol"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"987","DOI":"10.1001\/JAMAOPHTHALMOL.2017.2914","article-title":"Predictors of Corneal Perforation or Need for Therapeutic Keratoplasty in Severe Fungal Keratitis: A Secondary Analysis of the Mycotic Ulcer Treatment Trial II","volume":"135","author":"N V Prajna","year":"2017","journal-title":"JAMA Ophthalmol"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"339","DOI":"10.1038\/SJ.EYE.6703051","article-title":"Surgical management of corneal perforation secondary to gonococcal keratoconjunctivitis","volume":"23","author":"M Kawashima","year":"2009","journal-title":"Eye (Lond)"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"3547","DOI":"10.2147\/OPTH.S385782","article-title":"Surgical Management of Peripheral Ulcerative Keratitis: Update on Surgical Techniques and Their Outcome","volume":"16","author":"S Sabhapandit","year":"2022","journal-title":"Clin Ophthalmol"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"209","DOI":"10.2147\/OPTH.S394454","article-title":"Tissue Adhesives for the Management of Corneal Perforations and Challenging Corneal Conditions","volume":"17","author":"A Sharma","year":"2023","journal-title":"Clin Ophthalmol"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"437","DOI":"10.1046\/J.1442-9071.2000.00351.X","article-title":"Cyanoacrylate glue for corneal perforations: a description of a surgical technique and a review of the literature","volume":"28","author":"B J Vote","year":"2000","journal-title":"Clin Exp Ophthalmol"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"696","DOI":"10.1097\/ICO.0000000000000808","article-title":"Tenons patch graft in the management of large corneal perforations","volume":"35","author":"S Korah","year":"2016","journal-title":"Cornea"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"98","DOI":"10.1097\/ICO.0B013E31821F28A2","article-title":"Treatment of a large corneal perforation with a multilayer of amniotic membrane and TachoSil","volume":"31","author":"A E Grau","year":"2012","journal-title":"Cornea"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"1122","DOI":"10.1097\/ICO.0000000000002926","article-title":"Outcome of Lamellar Graft Patching for the Treatment of Noninfectious Corneal Perforations","volume":"41","author":"T Suzuki","year":"2022","journal-title":"Cornea"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"1120","DOI":"10.1016\/S0161-6420(98)96017-1","article-title":"Conjunctival flaps","volume":"105","author":"A M Alino","year":"1998","journal-title":"Ophthalmology"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"436","DOI":"10.1186\/S12886-023-03179-7","article-title":"DALK combined intralamellar tectonic patch graft: an alternative approach to treat frank corneal perforation","volume":"23","author":"G Xiao","year":"2023","journal-title":"BMC Ophthalmol"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"618","DOI":"10.1097\/ICO.0000000000002529","article-title":"Outcomes of Penetrating and Lamellar Corneal Patch Grafts","volume":"40","author":"S Sharma","year":"2021","journal-title":"Cornea"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"3547","DOI":"10.2147\/OPTH.S385782","article-title":"Surgical Management of Peripheral Ulcerative Keratitis: Update on Surgical Techniques and Their Outcome","volume":"16","author":"S Sabhapandit","year":"2022","journal-title":"Clin Ophthalmol"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"745","DOI":"10.1001\/JAMAOPHTHALMOL.2013.2474","article-title":"Autologous Fibrin Membrane Combined With Solid Platelet-Rich Plasma in the Management of Perforated Corneal Ulcers: A Pilot Study","volume":"131","author":"J L Alio","year":"2013","journal-title":"JAMA Ophthalmol"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"668","DOI":"10.1097\/ICO.0000000000001919","article-title":"Outcomes of Cyanoacrylate Tissue Adhesive Application in Corneal Thinning and Perforation","volume":"38","author":"J Yin","year":"2019","journal-title":"Cornea"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"243","DOI":"10.3238\/ARZTEBL.2011.0243","article-title":"Amniotic membrane transplantation in the human eye","volume":"108","author":"D Meller","year":"2011","journal-title":"Dtsch Arztebl Int"},{"issue":"S 3","key":"ref28","doi-asserted-by":"publisher","first-page":"S361","DOI":"10.4103\/IJO.IJO_300_24","article-title":"Amniotic membrane graft (AMG) for persistent epithelial defects following infective corneal ulcers and keratitis \u2013 A systematic review","volume":"73","author":"T Thevi","year":"2025","journal-title":"Indian J Ophthalmol"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"369","DOI":"10.1097\/01.ICO.0000151547.08113.D1","article-title":"Amniotic membrane transplantation and fibrin glue in the management of corneal ulcers and perforations: a review of 33 cases","volume":"24","author":"S Hick","year":"2005","journal-title":"Cornea"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"1455","DOI":"10.1136\/BJO.85.12.1455","article-title":"Single and multilayer amniotic membrane transplantation for persistent corneal epithelial defect with and without stromal thinning and perforation","volume":"85","author":"P Prabhasawat","year":"2001","journal-title":"Br J Ophthalmol"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"668","DOI":"10.1038\/S41433-023-02777-5","article-title":"Amniotic membrane transplantation: structural and biological properties, tissue preparation, application and clinical indications","volume":"38","author":"F WB Sanders","year":"2024","journal-title":"Eye (Lond)"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"1120","DOI":"10.1016\/S0161-6420(98)96017-1","article-title":"Conjunctival flaps","volume":"105","author":"A M Alino","year":"1998","journal-title":"Ophthalmology"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"1189","DOI":"10.1001\/ARCHOPHT.121.8.1189","article-title":"Microsurgical Approach to the Conjunctival Flap","volume":"121","author":"A Khodadoust","year":"2003","journal-title":"Arch Ophthalmol"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"70","DOI":"10.1097\/ICL.0000000000000590","article-title":"Conjunctival Flaps: A Case Series and Review of the Literature","volume":"46","author":"T D Oostra","year":"2020","journal-title":"Eye Contact Lens"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"207","DOI":"10.1016\/J.AJO.2020.11.006","article-title":"Comparative Study of Long-term Graft Survival Between Penetrating Keratoplasty and Deep Anterior Lamellar Keratoplasty","volume":"224","author":"A Arundhati","year":"2021","journal-title":"Am J Ophthalmol"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"311","DOI":"10.1016\/J.AJO.2004.09.045","article-title":"Corneal endothelium and postoperative outcomes 15 years after penetrating keratoplasty","volume":"139","author":"S V Patel","year":"2005","journal-title":"Am J Ophthalmol"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"615","DOI":"10.1016\/J.OPHTHA.2008.12.043","article-title":"Outcomes of Therapeutic Deep Lamellar Keratoplasty and Penetrating Keratoplasty for Advanced Infectious Keratitis: A Comparative Study","volume":"116","author":"A Anshu","year":"2009","journal-title":"Ophthalmology"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"14","DOI":"10.1016\/S0002-9394(01)00874-1","article-title":"Tectonic sclerokeratoplasty and tectonic penetrating keratoplasty as treatment for perforated or predescemetal corneal ulcers","volume":"132","author":"J B Jonas","year":"2001","journal-title":"Am J Ophthalmol"},{"issue":"S 2","key":"ref39","doi-asserted-by":"publisher","first-page":"S433","DOI":"10.1097\/ICL.0000000000000522","article-title":"Therapeutic Penetrating Keratoplasty: A Retrospective Review","volume":"44","author":"M Roozbahani","year":"2018","journal-title":"Eye Contact Lens"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"1265","DOI":"10.2147\/OPTH.S22959","article-title":"Outcome of penetrating keratoplasty in corneal ulcer: a single-center experience","volume":"5","author":"M R Sedghipour","year":"2011","journal-title":"Clin Ophthalmol"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"1176","DOI":"10.1136\/BJOPHTHALMOL-2015-307427","article-title":"Aetiology-specific comparison of long-term outcome of deep anterior lamellar keratoplasty for corneal diseases","volume":"100","author":"A Ogawa","year":"2016","journal-title":"Br J Ophthalmol"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"791","DOI":"10.2147\/OPTH.S20943","article-title":"Common complications of deep lamellar keratoplasty in the early phase of the learning curve","volume":"5","author":"M Hosny","year":"2011","journal-title":"Clin Ophthalmol"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"1749","DOI":"10.1016\/S0140-6736(12)60437-1","article-title":"Corneal transplantation","volume":"379","author":"D TH Tan","year":"2012","journal-title":"Lancet"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"1123","DOI":"10.1007\/S00417-008-0812-9","article-title":"Evaluation of different types of lamellar keratoplasty for treatment of peripheral corneal perforation","volume":"246","author":"T Huang","year":"2008","journal-title":"Graefes Arch Clin Exp Ophthalmol"},{"key":"ref45","doi-asserted-by":"publisher","first-page":"750","DOI":"10.1016\/j.ajo.2007.01.053","article-title":"Impact of the Descemet Membrane Perforation on Surgical Outcomes After Deep Lamellar Keratoplasty","volume":"143","author":"S Den","year":"2007","journal-title":"Am J Ophthalmol"},{"key":"ref46","doi-asserted-by":"publisher","first-page":"249","DOI":"10.1016\/J.OPHTHA.2011.07.057","article-title":"Long-term Results of Deep Anterior Lamellar versus Penetrating Keratoplasty","volume":"119","author":"V M Borderie","year":"2012","journal-title":"Ophthalmology"},{"key":"ref47","doi-asserted-by":"publisher","first-page":"209","DOI":"10.1016\/J.OPHTHA.2010.11.002","article-title":"Deep Anterior Lamellar Keratoplasty as an Alternative to Penetrating Keratoplasty: A Report by the American Academy of Ophthalmology","volume":"118","author":"W J Reinhart","year":"2011","journal-title":"Ophthalmology"}],"container-title":["Klinische Monatsbl\u00e4tter f\u00fcr Augenheilkunde"],"original-title":[],"language":"de","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2786-0438.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T22:35:08Z","timestamp":1776724508000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2786-0438"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4]]},"references-count":47,"journal-issue":{"issue":"04","published-online":{"date-parts":[[2026,4,20]]},"published-print":{"date-parts":[[2026,4]]}},"URL":"https:\/\/doi.org\/10.1055\/a-2786-0438","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0023-2165","1439-3999"],"issn-type":[{"value":"0023-2165","type":"print"},{"value":"1439-3999","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4]]}}}