{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T10:32:53Z","timestamp":1778754773743,"version":"3.51.4"},"reference-count":41,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2020,10,26]],"date-time":"2020-10-26T00:00:00Z","timestamp":1603670400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Xenotransplantation"],"published-print":{"date-parts":[[2021,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>To evaluate the effects of deep anterior lamellar keratoplasty (DALK) with cross\u2010linked acellular porcine corneal stroma (APCS) and post\u2010operative topical tacrolimus treatment in patients with fungal keratitis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This multicenter prospective study involved 25 cases of fungal keratitis that were treated by DALK with cross\u2010linked APCSs and post\u2010operative topical tacrolimus from December 2013 to November 2014 at the Wenzhou Eye Hospital and the Henan provincial Eye Hospital. Signs of post\u2010operative inflammation, corneal reepithelialization, corneal neovascularization, and graft rejection were assessed, and best corrected visual acuity (BCVA), intraocular pressure (IOP), and APCS graft transparency were monitored for the 12\u2010month follow\u2010up period.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>All 25 patients underwent DALK without Descemet's membrane perforation. Corneal epithelium recovered completely in 17 patients in the first week, and APCS grafts maintained transparency in 18 patients at 1\u2010year follow\u2010up. The mean BCVA significantly improved from 2.16\u00a0\u00b1\u00a00.32 (LogMAR) at baseline to 1.56\u00a0\u00b1\u00a00.70 at 1\u2010week (<jats:italic>P<\/jats:italic>\u00a0&lt;\u00a0.001), 0.95\u00a0\u00b1\u00a00.57 at 1\u2010month (<jats:italic>P<\/jats:italic>\u00a0&lt;\u00a0.001), and 0.70\u00a0\u00b1\u00a00.51 at 3\u2010month follow\u2010ups (<jats:italic>P<\/jats:italic>\u00a0&lt;\u00a0.001). The BCVA kept stable at 6\u2010month and 12\u2010month follow\u2010ups. Post\u2010operative topical tacrolimus alleviated the ciliary injection, except in one case which acute stromal rejection occurred. One patient developed fungal reinfection and underwent penetrating keratoplasty. Graft rejection occurred in three patients. No case was noted with graft splitting, elevated IOP or tacrolimus intolerance.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>DALK using cross\u2010linked APCS combining topical tacrolimus treatment is safe and effective in managing fungal keratitis. It may ameliorate the shortage of corneal donation globally.<\/jats:p><\/jats:sec>","DOI":"10.1111\/xen.12655","type":"journal-article","created":{"date-parts":[[2020,10,26]],"date-time":"2020-10-26T14:20:45Z","timestamp":1603722045000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Deep anterior lamellar keratoplasty with cross\u2010linked acellular porcine corneal stroma to manage fungal keratitis"],"prefix":"10.1111","volume":"28","author":[{"given":"Qinxiang","family":"Zheng","sequence":"first","affiliation":[{"name":"School of Ophthalmology and Optometry Wenzhou Medical University Zhejiang China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yueqin","family":"Zhang","sequence":"additional","affiliation":[{"name":"Henan Eye Institute Henan Eye Hospital Henan Provincial People's Hospital Zhengzhou 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