{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T08:41:14Z","timestamp":1782981674134,"version":"3.54.5"},"reference-count":33,"publisher":"MDPI AG","issue":"13","license":[{"start":{"date-parts":[[2024,6,28]],"date-time":"2024-06-28T00:00:00Z","timestamp":1719532800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"DFG-Gro\u00dfger\u00e4te-external","award":["31\/2017"],"award-info":[{"award-number":["31\/2017"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Acute keratoconus (acute KC), which affects approximately 1.6\u20132.8% of keratoconus (KC) patients, is a pathological condition of the cornea characterized by stromal edema due to entry of aqueous humor through a tear in Descemet\u2019s membrane. Methods: We present a novel combination of surgical procedures that allows swifter visual recovery in a consecutive, retrospective case series. The new surgical procedure for acute KC consists of a combination of Muraine corneal sutures to smooth the corneal curvature and Excimer laser-assisted penetrating keratoplasty and was performed in six acute KC patients from 2019 to 2022 at the Department of Ophthalmology, University Hospital of Martin-Luther-University Halle-Wittenberg (UMH), Germany. We monitored data on preoperative status, operative details, intraoperative and postoperative complications and visual outcomes were analyzed. Results: The mean age was 41.5 \u00b1 13.5 years (3 OD, 3 OS). Neurodermatitis was present in 3 patients (50%). All patients received significant visual benefits from the procedure. Preoperative BCVA was hand motion (logMAR 3.0) in all patients; postoperatively, BCVA improved significantly logMAR 0.03 \u00b1 0.09 [range: 0.2\u20130.4; p &lt; 0.001, FUP 20+\/\u221210 months). Visual acuity remained stable throughout the roughly biannual follow-ups. One patient developed endothelial graft rejection after 2 years. During the last examination, all eyes had clear grafts and stable curvatures, K1 and K2 being 42.43 \u00b1 4.17 D and 44.95 \u00b1 4.07 D, respectively, and mean corneal astigmatism was 2.61 \u00b1 1.74 D. The thinnest corneal thickness was 519 \u00b1 31 \u00b5m. A graft size of 8.0 \u00d7 8.1 mm was the most beneficial. Conclusions: in patients with acute KC and hydrops, a penetrating keratoplasty with Muraine corneal sutures is successful in terms of graft clarity and visual outcome. Combining the procedures allows quicker visual recovery. Patients with a history of neurodermatitis should have preoperative and postoperative dermatologic treatment and close follow-up for possible complications.<\/jats:p>","DOI":"10.3390\/jcm13133792","type":"journal-article","created":{"date-parts":[[2024,6,28]],"date-time":"2024-06-28T03:42:30Z","timestamp":1719546150000},"page":"3792","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Simultaneous Muraine Sutures and Excimer Laser-Assisted Penetrating Keratoplasty for Acute Keratoconus"],"prefix":"10.3390","volume":"13","author":[{"given":"Marie Elisabeth","family":"Burghardt","sequence":"first","affiliation":[{"name":"Department of Ophthalmology, UMH, Martin-Luther-University Halle-Wittenberg, 06120 Halle (Saale), Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0384-0622","authenticated-orcid":false,"given":"Joana","family":"Heinzelmann","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, UMH, Martin-Luther-University Halle-Wittenberg, 06120 Halle (Saale), Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marlene","family":"Stein","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, UMH, Martin-Luther-University Halle-Wittenberg, 06120 Halle (Saale), Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anja","family":"Viestenz","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, UMH, Martin-Luther-University Halle-Wittenberg, 06120 Halle (Saale), Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arne","family":"Viestenz","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, UMH, Martin-Luther-University Halle-Wittenberg, 06120 Halle (Saale), Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,6,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"101559","DOI":"10.1016\/j.clae.2021.101559","article-title":"Keratoconus: An updated review","volume":"45","author":"Carracedo","year":"2022","journal-title":"Contact Lens Anterior Eye"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1069","DOI":"10.1007\/s00347-021-01410-8","article-title":"Stage-appropriate treatment of keratoconus","volume":"118","author":"Seitz","year":"2021","journal-title":"Ophthalmologe"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"461","DOI":"10.4103\/0301-4738.116062","article-title":"Acute corneal hydrops in keratoconus","volume":"61","author":"Sharma","year":"2013","journal-title":"Indian J. 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