{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T14:40:05Z","timestamp":1767969605394,"version":"3.49.0"},"reference-count":10,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T00:00:00Z","timestamp":1767916800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Ocular graft-versus-host disease (oGVHD) is a chronic, immune-mediated complication of allogeneic hematopoietic stem cell transplantation that can progress to corneal ulceration or perforation. These cases are often refractory to standard therapy and present a high risk of graft failure after keratoplasty. We report a case of oGVHD-related corneal perforation successfully managed with a novel amniotic membrane-assisted \u201cenvelope\u201d technique during corneal transplantation. Case Report: A 42-year-old man with chronic oGVHD and a full-thickness corneal perforation underwent urgent repair with a lamellar patch graft completely wrapped in cryopreserved amniotic membrane, followed by penetrating keratoplasty (PKP) using an amniotic membrane envelope surrounding the donor lenticule. Results: The amniotic membrane provided a 360\u00b0 biological barrier that isolated graft antigens from the inflammatory environment while supporting epithelial healing and stromal remodeling. Despite recurrent inflammatory episodes and multiple procedures\u2014including cataract extraction, pars plana vitrectomy, and multilayer amniotic membrane transplantation\u2014the graft remained clear and stable at 12-month follow-up, achieving a best-corrected visual acuity of 20\/40. Conclusions: The amniotic membrane envelope technique may represent a valuable adjunct in managing high-risk corneal perforations secondary to oGVHD. By combining immune modulation and regenerative support, this approach can enhance tectonic stability, reduce rejection risk, and promote durable surface recovery, potentially delaying or avoiding keratoprosthesis in refractory cases.<\/jats:p>","DOI":"10.3390\/jcm15020548","type":"journal-article","created":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T11:45:33Z","timestamp":1767959133000},"page":"548","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Amniotic Membrane-Assisted Corneal Transplantation in Ocular Perforation Due to GVHD: A Case Report"],"prefix":"10.3390","volume":"15","author":[{"given":"Nicola","family":"Cardascia","sequence":"first","affiliation":[{"name":"UOC Oftalmologia Universitaria, Ospedale Consorziale Policlinico di Bari, Universit\u00e0 degli Studi di Bari, 70121 Bari, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria Gabriella","family":"La Tegola","sequence":"additional","affiliation":[{"name":"UOC Oftalmologia Universitaria, Ospedale Consorziale Policlinico di Bari, Universit\u00e0 degli Studi di Bari, 70121 Bari, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5702-8595","authenticated-orcid":false,"given":"Francesco","family":"D\u2019Oria","sequence":"additional","affiliation":[{"name":"UOC Oftalmologia Universitaria, Ospedale Consorziale Policlinico di Bari, Universit\u00e0 degli Studi di Bari, 70121 Bari, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giacomo","family":"Boscia","sequence":"additional","affiliation":[{"name":"UOC Oftalmologia, Ente Ecclesiastico, Ospedale Generale Regionale \u201cF. Miulli\u201d, 70021 Acquaviva delle Fonti, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesco","family":"Boscia","sequence":"additional","affiliation":[{"name":"UOC Oftalmologia Universitaria, Ospedale Consorziale Policlinico di Bari, Universit\u00e0 degli Studi di Bari, 70121 Bari, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8313-4159","authenticated-orcid":false,"given":"Giovanni","family":"Alessio","sequence":"additional","affiliation":[{"name":"UOC Oftalmologia Universitaria, Ospedale Consorziale Policlinico di Bari, Universit\u00e0 degli Studi di Bari, 70121 Bari, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"697","DOI":"10.1016\/j.survophthal.2023.02.006","article-title":"Ocular graft-versus-host disease (oGVHD): From A to Z","volume":"68","author":"Soleimani","year":"2023","journal-title":"Surv. Ophthalmol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"540","DOI":"10.1097\/ACI.0b013e328357b4b9","article-title":"Ocular graft-versus-host disease","volume":"12","author":"Hessen","year":"2012","journal-title":"Curr. Opin. Allergy Clin. Immunol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"668","DOI":"10.1038\/s41433-023-02777-5","article-title":"Amniotic membrane transplantation: Structural and biological properties, tissue preparation, application and clinical indications","volume":"38","author":"Sanders","year":"2024","journal-title":"Eye"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Ikarashi, H., Aketa, N., Shimizu, E., Takano, Y., Kawakita, T., Uchino, Y., Matsumoto, Y., Ogawa, J., Tsubota, K., and Ogawa, Y. (2021). Two case reports of continued progression of chronic ocular graft-versus-host disease without concurrent systemic comorbidities treated by amniotic membrane transplantation. BMC Ophthalmol., 21.","DOI":"10.1186\/s12886-021-01925-3"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"314","DOI":"10.1016\/j.jtos.2018.04.001","article-title":"Ocular chronic graft-versus-host disease after allogeneic hematopoietic stem cell transplantation in an Italian referral center","volume":"16","author":"Berchicci","year":"2018","journal-title":"Ocul. Surf."},{"key":"ref_6","first-page":"598","article-title":"Four cases of corneal perforation in patients with chronic graft-versus-host disease","volume":"17","author":"Inagaki","year":"2011","journal-title":"Mol. Vis."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"2153","DOI":"10.2147\/OPTH.S51180","article-title":"Bilateral corneal ulceration in ocular graft-versus-host disease","volume":"7","author":"Stevenson","year":"2013","journal-title":"Clin. Ophthalmol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1428","DOI":"10.1007\/s12015-025-10892-x","article-title":"Amniotic Membrane Transplantation for Wound Healing, Tissue Regeneration and Immune Modulation","volume":"21","author":"Parmar","year":"2025","journal-title":"Stem Cell Rev. Rep."},{"key":"ref_9","first-page":"CD009379","article-title":"Amniotic membrane transplantation for acute ocular burns","volume":"9","author":"Clare","year":"2022","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"25254","DOI":"10.1038\/s41598-024-76249-5","article-title":"Visual and ocular surface benefits of mini-scleral contact lenses in patients with chronic ocular graft-versus-host disease (GvHD)","volume":"14","author":"Keye","year":"2024","journal-title":"Sci. Rep."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/2\/548\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T11:53:11Z","timestamp":1767959591000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/2\/548"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,9]]},"references-count":10,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,1]]}},"alternative-id":["jcm15020548"],"URL":"https:\/\/doi.org\/10.3390\/jcm15020548","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,9]]}}}