{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T02:37:47Z","timestamp":1783996667316,"version":"3.55.0"},"reference-count":15,"publisher":"F1000 Research Ltd","license":[{"start":{"date-parts":[[2023,5,19]],"date-time":"2023-05-19T00:00:00Z","timestamp":1684454400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100005809","name":"Hyderabad Eye Research Foundation","doi-asserted-by":"publisher","award":["Intra-muralresearchgrant"],"award-info":[{"award-number":["Intra-muralresearchgrant"]}],"id":[{"id":"10.13039\/501100005809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["f1000research.com"],"crossmark-restriction":false},"short-container-title":["F1000Res"],"abstract":"<ns4:p>\n                    <ns4:bold>Introduction:<\/ns4:bold>\n                  <\/ns4:p>\n                  <ns4:p>This report describes the use of conjunctival flaps to enable the survival of type I keratoprosthesis (KPro) in two cases of bilateral severe total limbal stem cell deficiency (LSCD) following chemical burns.<\/ns4:p>\n                  <ns4:p>\n                    <ns4:bold>Presentation of case:<\/ns4:bold>\n                  <\/ns4:p>\n                  <ns4:p>Two patients had a history of bilateral chemical injury with lime. On examination, the presenting vision was light perception to hand motions and both cases had conjunctivalized ocular surfaces with symblepharon. A modified technique of type I keratoprosthesis was used, where the conjunctivalized corneal pannus was dissected and lifted off as an inferior fornix-based conjunctival flap. This was followed by a standard surgical technique of type I KPro. The flap was then secured over the device and optical opening was made two weeks later. Both the patients had stable ocular surfaces with visual acuity of 20\/20 at 2\u20137 years of follow-up.<\/ns4:p>\n                  <ns4:p>\n                    <ns4:bold>Discussion:<\/ns4:bold>\n                  <\/ns4:p>\n                  <ns4:p>In patients with total LSCD with adnexal involvement, type I KPro has unsatisfactory long-term survival because of the risk of repeated epithelial breakdowns and stromal ulceration. With the innovative approach described in this report, type I KPro can be successfully used for sustainable visual improvement in the presence of severe ocular surface disease and symblepharon.<\/ns4:p>\n                  <ns4:p>\n                    <ns4:bold>Conclusion:<\/ns4:bold>\n                  <\/ns4:p>\n                  <ns4:p>Conjunctival flaps can be used along with type I KPros to improve long-term survival and give sustainable visual outcomes in cases of bilateral corneal blindness due to advanced ocular surface damage.<\/ns4:p>","DOI":"10.12688\/f1000research.131492.1","type":"journal-article","created":{"date-parts":[[2023,5,19]],"date-time":"2023-05-19T10:05:06Z","timestamp":1684490706000},"page":"521","update-policy":"https:\/\/doi.org\/10.12688\/f1000research.crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Successful use of conjunctival flaps to prolong survival of type I keratoprosthesis in severe bilateral chemical burns: two case reports"],"prefix":"10.12688","volume":"12","author":[{"given":"Sheetal","family":"Mahuvakar","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neha","family":"Jain","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5030-5003","authenticated-orcid":false,"given":"Sayan","family":"Basu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2560","published-online":{"date-parts":[[2023,5,19]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"272-281","DOI":"10.1016\/j.jtos.2018.03.007","article-title":"Boston keratoprosthesis type 1 for limbal stem cell deficiency after severe chemical corneal injury: A systematic review.","volume":"16","author":"S Shanbhag","year":"2018 Jul","journal-title":"Ocul. Surf."},{"key":"ref2","doi-asserted-by":"publisher","first-page":"385-388","DOI":"10.1097\/ICU.0000000000000774","article-title":"Challenges in management of the Boston Keratoprosthesis Type 1.","volume":"32","author":"E Koo","year":"2021","journal-title":"Curr. Opin. Ophthalmol."},{"key":"ref3","doi-asserted-by":"publisher","first-page":"911-916","DOI":"10.1097\/ICO.0000000000000837","article-title":"Boston Keratoprosthesis Type 1 in Chemical Burns.","volume":"35","author":"B Salvador-Culla","year":"2016","journal-title":"Cornea."},{"key":"ref4","doi-asserted-by":"publisher","first-page":"350-364","DOI":"10.1016\/j.jtos.2016.02.006","article-title":"Surgical Management of Bilateral Limbal Stem Cell Deficiency.","volume":"14","author":"J Vazirani","year":"2016","journal-title":"Ocul. Surf."},{"key":"ref5","doi-asserted-by":"publisher","first-page":"555-560","DOI":"10.3109\/09273948.2015.1037458","article-title":"The Usage of a Conjunctival Flap to Improve Retention of Boston Type 1 Keratoprosthesis in Severe Ocular Surface Disease.","volume":"24","author":"A Eghrari","year":"2016","journal-title":"Ocul. Immunol. Inflamm."},{"key":"ref6","doi-asserted-by":"publisher","first-page":"1187-1194","DOI":"10.1097\/ICO.0b013e3182114467","article-title":"The Boston keratoprosthesis in the management of corneal limbal stem cell deficiency.","volume":"30","author":"K Sejpal","year":"2011","journal-title":"Cornea."},{"key":"ref7","doi-asserted-by":"publisher","first-page":"989-996","DOI":"10.1097\/ICO.0b013e3181a186dc","article-title":"Boston keratoprosthesis outcomes and complications.","volume":"28","author":"H Chew","year":"2009","journal-title":"Cornea."},{"key":"ref8","doi-asserted-by":"publisher","first-page":"226-230","DOI":"10.1016\/j.ijsu.2020.10.034","article-title":"The SCARE 2020 Guideline: Updating Consensus Surgical CAse REport (SCARE) Guidelines.","volume":"84","author":"R Agha","year":"2020","journal-title":"International journal of surgery (London, England)."},{"key":"ref9","doi-asserted-by":"publisher","first-page":"1384-1386","DOI":"10.1038\/eye.2012.144","article-title":"Management of skin retraction associated with Boston type II keratoprosthesis.","volume":"26","author":"M Nanavaty","year":"2012","journal-title":"Eye (Lond.)."},{"key":"ref10","doi-asserted-by":"publisher","first-page":"211-224","DOI":"10.1111\/j.1442-9071.2010.02231.x","article-title":"Keratoprostheses in clinical practice - a review.","volume":"38","author":"A Gomaa","year":"2010","journal-title":"Clin. Exp. Ophthalmol."},{"key":"ref11","first-page":"12-18","article-title":"Temporary tissue coverage in keratoprosthesis.","author":"J Al-Merjan","year":"2000","journal-title":"Middle East J Ophthalmol."},{"key":"ref12","first-page":"936-961","article-title":"Prosthetosclerokeratoplasty-implantation of a keratoprosthesis using full-thickness onlay sclera and sliding conjunctival flap.","volume":"73","author":"L Girard","year":"1969","journal-title":"Transactions - American Academy of Ophthalmology and Otolaryngology American Academy of Ophthalmology and Otolaryngology."},{"key":"ref13","article-title":"Total Conjunctival Flap in KPro Surgery. Boston KPro Newsletter.","author":"C Dohlman","year":"2016"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"e4-e6","DOI":"10.1097\/ICL.0b013e31824daad2","article-title":"Stromal melting associated with a cosmetic contact lens over a Boston keratoprosthesis: treatment with a conjunctival flap.","volume":"39","author":"O Adesina","year":"2013","journal-title":"Eye Contact Lens."},{"key":"ref15","doi-asserted-by":"publisher","first-page":"1516-1519","DOI":"10.1097\/ICO.0b013e3182a480f5","article-title":"Oral buccal mucous membrane allograft with a corneal lamellar graft for the repair of Boston type 1 keratoprosthesis stromal melts.","volume":"32","author":"S Ziai","year":"2013","journal-title":"Cornea."}],"container-title":["F1000Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/f1000research.com\/articles\/12-521\/v1\/xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/f1000research.com\/articles\/12-521\/v1\/pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/f1000research.com\/articles\/12-521\/v1\/iparadigms","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,31]],"date-time":"2023-10-31T07:40:17Z","timestamp":1698738017000},"score":1,"resource":{"primary":{"URL":"https:\/\/f1000research.com\/articles\/12-521\/v1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,5,19]]},"references-count":15,"URL":"https:\/\/doi.org\/10.12688\/f1000research.131492.1","relation":{"has-review":[{"id-type":"doi","id":"10.5256\/f1000research.144340.r183670","asserted-by":"subject"},{"id-type":"doi","id":"10.5256\/f1000research.144340.r214602","asserted-by":"subject"},{"id-type":"doi","id":"10.5256\/f1000research.144340.r214602","asserted-by":"object"},{"id-type":"doi","id":"10.5256\/f1000research.144340.r183670","asserted-by":"object"}]},"ISSN":["2046-1402"],"issn-type":[{"value":"2046-1402","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,5,19]]},"assertion":[{"value":"Indexed","URL":"https:\/\/f1000research.com\/articles\/12-521\/v1#article-reports","order":0,"name":"referee-status","label":"Referee status","group":{"name":"current-referee-status","label":"Current Referee Status"}},{"value":"10.5256\/f1000research.144340.r183670, Amit Raj, Prabhakar Singh, All India Institute of Medical Sciences, Patna, Bihar, 27 Jul 2023, version 1, indexed","URL":"https:\/\/f1000research.com\/articles\/12-521\/v1#referee-response-183670","order":0,"name":"referee-response-183670","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.5256\/f1000research.144340.r214602, Jiaqi Chen, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, 31 Oct 2023, version 1, indexed","URL":"https:\/\/f1000research.com\/articles\/12-521\/v1#referee-response-214602","order":1,"name":"referee-response-214602","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"This study was supported by an intra-mural research grant from the Hyderabad Eye Research Foundation. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.","order":2,"name":"grant-information","label":"Grant Information"},{"value":"This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.","order":0,"name":"copyright-info","label":"Copyright"}]}}