{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,13]],"date-time":"2026-06-13T05:04:36Z","timestamp":1781327076381,"version":"3.54.1"},"reference-count":24,"publisher":"BMJ","issue":"5","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Br J Ophthalmol"],"accepted":{"date-parts":[[2024,11,9]]},"published-print":{"date-parts":[[2025,5]]},"abstract":"<jats:sec>\n                  <jats:title>Background\/Aims<\/jats:title>\n                  <jats:p>To explore the outcomes of conjunctival flap (CF) followed by keratoplasty in patients with severe infectious keratitis (IK) unresponsive to medical treatment.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>This is a retrospective monocentric study including 29 eyes of 29 patients with IK resistant to antibiotic treatment associated with stromal ulcer deepening to \u226550% of corneal thickness. All eyes underwent Gundersen\u2019s CF procedure and penetrating keratoplasty (PK), deep anterior lamellar keratoplasty (DALK) or mushroom keratoplasty (MK), at least 4 months thereafter. Outcome measures included corrected distance visual acuity (CDVA), endothelial cell count (ECC), graft survival and complications.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>IK healed in all eyes following CF. The mean time interval between CF and keratoplasty was 16.3\u00b116.1 months. 55% of patients underwent PK, 35% MK and 10% DALK. Mean follow-up duration was 39.6\u00b134.3 months. At the last available follow-up, a CDVA\u226520\/200 was obtained in 50%, 33.3% and 70% of cases, respectively after PK, DALK and MK. Mean annual endothelial cell loss was 24.5% following PK and 10.7% following MK. Overall, graft failure occurred in 75% of cases after PK, 100% after DALK and 20% after MK. The most frequent complications were endothelial decompensation without immunological rejection (34.5%, after 31.1\u00b125.1 months) and graft rejection (17.2%, after 10.2\u00b17.9 months, all in the PK group).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>CF surgery followed by staged keratoplasty represents an alternative therapeutic approach to avoid high-risk keratoplasty \u2018a chaud\u2019 in cases of severe IK.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bjo-2024-326225","type":"journal-article","created":{"date-parts":[[2024,12,6]],"date-time":"2024-12-06T13:20:12Z","timestamp":1733491212000},"page":"561-564","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Outcomes of staged conjunctival flap and corneal transplantation for infectious keratitis resistant to medical treatment"],"prefix":"10.1136","volume":"109","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7410-8805","authenticated-orcid":false,"given":"Raphael","family":"Kilian","sequence":"first","affiliation":[{"name":"Department of Translational Medicine and for Romagna, University of Ferrara, Ferrara, Italy"},{"name":"Istituto Internazionale per la Ricerca e Formazione in Oftalmologia (IRFO), Forl\u00ec, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6419-6941","authenticated-orcid":false,"given":"Marco","family":"Pellegrini","sequence":"additional","affiliation":[{"name":"Department of Translational Medicine and for Romagna, University of Ferrara, Ferrara, Italy"},{"name":"Istituto Internazionale per la Ricerca e Formazione in Oftalmologia (IRFO), Forl\u00ec, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5654-3942","authenticated-orcid":false,"given":"Angeli Christy","family":"Yu","sequence":"additional","affiliation":[{"name":"Department of Translational Medicine and for Romagna, University of Ferrara, Ferrara, Italy"},{"name":"Istituto Internazionale per la Ricerca e Formazione in Oftalmologia (IRFO), Forl\u00ec, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-8967-4661","authenticated-orcid":false,"given":"Valentino","family":"de Ruvo","sequence":"additional","affiliation":[{"name":"Department of Translational Medicine and for Romagna, University of Ferrara, Ferrara, Italy"},{"name":"Istituto Internazionale per la Ricerca e Formazione in Oftalmologia (IRFO), Forl\u00ec, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9766-3668","authenticated-orcid":false,"given":"Niccol\u00f2","family":"Salgari","sequence":"additional","affiliation":[{"name":"Department of Translational Medicine and for Romagna, University of Ferrara, Ferrara, Italy"},{"name":"Istituto Internazionale per la Ricerca e Formazione in Oftalmologia (IRFO), Forl\u00ec, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3635-3521","authenticated-orcid":false,"given":"Massimo","family":"Busin","sequence":"additional","affiliation":[{"name":"Department of Translational Medicine and for Romagna, University of Ferrara, Ferrara, Italy"},{"name":"Istituto Internazionale per la Ricerca e Formazione in Oftalmologia (IRFO), Forl\u00ec, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2024,12,6]]},"reference":[{"key":"2025071523150773000_109.5.561.1","unstructured":"Feder RS . 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