{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T19:35:31Z","timestamp":1786649731122,"version":"build-2736575974"},"reference-count":13,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2022,2]]},"abstract":"<jats:p>Systemic tuberculosis mostly affects the lungs and ocular involvement is rare. The ocular manifestations are varied, and rarely peripheral ulcerative keratitis (PUK) occurs either due to direct invasion of the microorganism or due to immune reaction. We present a case of advanced PUK in a 28-year-old male patient diagnosed with pulmonary TB in the right eye with hourglass cornea. The ulcer was progressing circumferentially with necrosis of corneal stroma and undermined margins similar to Moorens ulcer, and was not responding to anti-tuberculosis treatment and topical steroids. We describe a modified novel surgical technique using tenons sling annular patch graft to manage the progressive advanced PUK with hourglass cornea to optimize visual and structural outcome in our patient.<\/jats:p>","DOI":"10.4103\/ijo.ijo_2035_21","type":"journal-article","created":{"date-parts":[[2022,2,16]],"date-time":"2022-02-16T07:51:02Z","timestamp":1644997862000},"page":"655-657","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":8,"title":["A modified Tenons sling annular graft for advanced peripheral ulcerative keratitis with an hourglass cornea"],"prefix":"10.4103","volume":"70","author":[{"given":"Venugopal","family":"Anitha","sequence":"first","affiliation":[{"name":"Department of Cornea, Ocular Surface, Trauma and Refractive Services, Tirunelveli, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aditya","family":"Ghorpade","sequence":"additional","affiliation":[{"name":"Department of Cornea and Refractive Services, Tirunelveli, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meenakshi","family":"Ravindran","sequence":"additional","affiliation":[{"name":"Department of Paediatrics and Strabismology, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Tirunelveli, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2022,1,27]]},"reference":[{"key":"R1-20251006","doi-asserted-by":"crossref","first-page":"463","DOI":"10.1016\/S0161-6420(88)33164-7","article-title":"Inflammatory diseases of the peripheral cornea","volume":"95","author":"Mondino","year":"1988","journal-title":"Ophthalmology"},{"key":"R2-20251006","first-page":"7","article-title":"Mooren's ulcer:Current concepts in management","volume":"45","author":"Sangwan","year":"1997","journal-title":"Indian J Ophthalmol"},{"key":"R3-20251006","doi-asserted-by":"crossref","first-page":"951","DOI":"10.1097\/ICO.0000000000001955","article-title":"Tuck-in tenon patch graft in corneal perforation","volume":"38","author":"Sharma","year":"2019","journal-title":"Cornea"},{"key":"R4-20251006","doi-asserted-by":"crossref","DOI":"10.1128\/microbiolspec.TNMI7-0001-2016","article-title":"Ocular tuberculosis","volume":"4","author":"Albert","year":"2016","journal-title":"Microbiol Spectr"},{"key":"R5-20251006","doi-asserted-by":"crossref","first-page":"205","DOI":"10.4103\/0974-620X.169888","article-title":"Peripheral ulcerative keratitis associated with chronic malabsorption syndrome and miliary tuberculosis in a child","volume":"8","author":"Arora","year":"2015","journal-title":"Oman J Ophthalmol"},{"key":"R6-20251006","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1159\/000439426","article-title":"Ocular tuberculosis with progressive unilateral corneal melting","volume":"6","author":"Bayraktutar","year":"2015","journal-title":"Case Rep Ophthalmol"},{"key":"R8-20251006","doi-asserted-by":"crossref","first-page":"703","DOI":"10.1038\/eye.1995.182","article-title":"Collagenase (MMP-1) and TIMP-1 in destructive corneal disease associated with rheumatoid arthritis","volume":"9","author":"Riley","year":"1995","journal-title":"Eye (Lond)"},{"key":"R9-20251006","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1016\/j.joco.2018.03.001","article-title":"Autoimmune keratitis in mycobacterium tuberculosis","volume":"30","author":"Rafiezadeh","year":"2018","journal-title":"J Curr Ophthalmol"},{"key":"R10-20251006","doi-asserted-by":"crossref","first-page":"bcr2017222571","DOI":"10.1136\/bcr-2017-222571","article-title":"Immune stromal keratitis:A rare ocular presentation of tuberculosis","volume":"2018","author":"Singhal","year":"2018","journal-title":"BMJ Case Rep"},{"key":"R11-20251006","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1136\/bjo.66.6.341","article-title":"Light and electron microscopy of corneal melting syndrome (Mooren's ulcer)","volume":"66","author":"Young","year":"1982","journal-title":"Br J Ophthalmol"},{"key":"R12-20251006","doi-asserted-by":"crossref","first-page":"7","DOI":"10.4103\/ijo.IJO_1151_19","article-title":"Management of corneal perforations:An update","volume":"68","author":"Deshmukh","year":"2020","journal-title":"Indian J Ophthalmol"},{"key":"R13-20251006","doi-asserted-by":"crossref","first-page":"522","DOI":"10.1016\/j.survophthal.2011.06.003","article-title":"Management of corneal perforation","volume":"56","author":"Jhanji","year":"2011","journal-title":"Surv Ophthalmol"},{"key":"R14-20251006","doi-asserted-by":"crossref","first-page":"611","DOI":"10.1111\/j.1442-9071.2011.02745.x","article-title":"Anatomy of tenons capsule","volume":"40","author":"Kakizaki","year":"2012","journal-title":"Clin Exp Ophthalmol"}],"container-title":["Indian Journal of Ophthalmology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/ijo.IJO_2035_21","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T18:57:45Z","timestamp":1786647465000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/ijo.IJO_2035_21"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,1,27]]},"references-count":13,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2022]]}},"URL":"https:\/\/doi.org\/10.4103\/ijo.ijo_2035_21","relation":{},"ISSN":["0301-4738","1998-3689"],"issn-type":[{"value":"0301-4738","type":"print"},{"value":"1998-3689","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,1,27]]},"assertion":[{"value":"2021-08-01","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-10-14","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}