{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:16:53Z","timestamp":1787026613584,"version":"build-2736575974"},"reference-count":6,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,10,21]],"date-time":"2024-10-21T00:00:00Z","timestamp":1729468800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"\n Purpose<\/jats:title>\n To report a case of a patient with ocular surface alkali burn who developed corneal perforation before entering a stable phase. This patient was treated with a custom-designed lamellar graft using a Two-Step lamellar keratoplasty (LK) after 3\u2009months alkali burn.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n This study was a case report.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n A 43-year-old male patient who presented with redness, pain, and decreased vision in his left eye following lime exposure. Initial treatment involved amniotic membrane transplantation and anterior chamber irrigation. However, the patient subsequently developed corneal infiltration and progressive thinning. The patient refused the corneal transplantation and ultimately underwent tarsorrhaphy. Twenty days postoperatively, the patient experienced sudden ocular pain and central corneal perforation. Considering the potential complications of conventional corneal transplantation, including stem cell deficiency, graft dissolution, and rejection, a personalized Two-Step LK was devised. Following this procedure, the patient\u2019s vision gradually improved to 20\/133 (without correction), with a good corneal condition but mild epithelial defects and edema. At the 8-month follow-up, subepithelial corneal haze was observed, but uncorrected visual acuity remained stable at 20\/133 and best corrected visual acuity was up to 20\/66.<\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n For patients with ocular surface alkali burns who experience persistent disease progression despite early and mid-stage aggressive interventions, this study is the first to report on the use of a Two-Step LK. This approach takes into account both the \u201csoil\u201d factors that may lead to graft dissolution and the \u201cseed\u201d factors related to recipient stem cell deficiency. The results in preventing graft dissolution and maintaining postoperative corneal function are encouraging.<\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fmed.2024.1496083","type":"journal-article","created":{"date-parts":[[2024,10,21]],"date-time":"2024-10-21T00:39:39Z","timestamp":1729471179000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Case report: Two-step lamellar keratoplasty for alkali burns"],"prefix":"10.3389","volume":"11","author":[{"given":"Xie","family":"Fang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhiwen","family":"Xie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shunrong","family":"Luo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xianwen","family":"Xiao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhengwei","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuan","family":"Lin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huping","family":"Wu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2024,10,21]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1362","DOI":"10.1038\/s41433-019-0456-5","article-title":"An update on chemical eye burns","volume":"33","author":"Bizrah","year":"2019","journal-title":"Eye (Lond)"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"2001","DOI":"10.1038\/s41433-020-1026-6","article-title":"Chemical eye injury: pathophysiology, assessment and management","volume":"34","author":"Dua","year":"2020","journal-title":"Eye (Lond)"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"7075","DOI":"10.3390\/ijms23137075","article-title":"Th17 activation and Th17\/Treg imbalance in prolonged anterior intraocular inflammation after ocular alkali burn","volume":"23","author":"Yuan","year":"2022","journal-title":"Int J Mol Sci"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"731","DOI":"10.1001\/jamaophthalmol.2013.2308","article-title":"Cultivated limbal epithelial transplantation in children with ocular surface burns","volume":"131","author":"Sejpal","year":"2013","journal-title":"JAMA Ophthalmol"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"214","DOI":"10.1016\/j.survophthal.2017.09.005","article-title":"Treatment of acute ocular chemical burns","volume":"63","author":"Sharma","year":"2018","journal-title":"Surv Ophthalmol"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"E1028","DOI":"10.1503\/cmaj.190428","article-title":"Chemical injuries of the eye","volume":"191","author":"Kwok","year":"2019","journal-title":"CMAJ"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2024.1496083\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,10,21]],"date-time":"2024-10-21T00:39:41Z","timestamp":1729471181000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2024.1496083\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,10,21]]},"references-count":6,"alternative-id":["10.3389\/fmed.2024.1496083"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2024.1496083","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,10,21]]},"article-number":"1496083"}}