{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T14:20:06Z","timestamp":1787840406834,"version":"build-2784847793"},"reference-count":11,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2024,1]]},"abstract":"<jats:p>We describe customized therapeutic deep anterior lamellar keratoplasty (DALK) for treating a perforated Mooren\u2019s ulcer. Slit-lamp biomicroscopy revealed corneal perforation (3.5 mm \u00d7 3.0 mm) with iris prolapse. The corneal melt extended from 9.0 o\u2019clock to 4.0 o\u2019clock. The peripheral edge of the ulcer was sloping, whereas the medial edge showed undermining. Immunological tests did not reveal any evidence of systemic autoimmune disease. In view of extensive peripheral corneal melt with large corneal perforation, the patient needed tectonic keratoplasty. The penetrating graft is not only technically demanding but also results in a poor visual outcome. We advised customized tectonic DALK. We used two different-sized trephines to obtain appropriate-sized donor tissue and avoided manual dissection. The post-surgery period was uneventful. He was prescribed topical steroids and oral methotrexate. He achieved 6\/9 aided visual acuity at 4 months and maintained it until the last follow-up at 36 months.<\/jats:p>","DOI":"10.4103\/ijo.ijo_964_23","type":"journal-article","created":{"date-parts":[[2023,12,22]],"date-time":"2023-12-22T01:02:51Z","timestamp":1703206971000},"page":"130-133","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":2,"title":["Customized therapeutic deep anterior lamellar keratoplasty in perforated Mooren\u2019s ulcer: A novel technique"],"prefix":"10.4103","volume":"72","author":[{"given":"Ashok","family":"Sharma","sequence":"first","affiliation":[{"name":"Cornea Centre, SCO 2463-2464, Sector 22 C, 160022, Chandigarh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajan","family":"Sharma","sequence":"additional","affiliation":[{"name":"Cornea Centre, SCO 2463-2464, Sector 22 C, 160022, Chandigarh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2023,12,22]]},"reference":[{"key":"R1-20260508","first-page":"7","article-title":"Mooren\u2019s ulcer: Current concepts in management","volume":"45","author":"Sangwan","year":"1997","journal-title":"Indian J Ophthalmol"},{"key":"R2-20260508","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1016\/j.sjopt.2018.11.004","article-title":"Aggressive Mooren\u2019s Ulcer and challenges in its management: Tale of three patients in pictures","volume":"33","author":"Farooqui","year":"2019","journal-title":"Saudi J Ophthalmol"},{"key":"R3-20260508","doi-asserted-by":"crossref","first-page":"8978527","DOI":"10.1155\/2017\/8978527","article-title":"Clinical characteristics and risk factors of recurrent Mooren\u2019s Ulcer","volume":"2017","author":"Yang","year":"2017","journal-title":"J Ophthalmol"},{"key":"R4-20260508","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1016\/S0161-6420(02)01558-0","article-title":"Fibrin glue versus N-butyl-2-cyanoacrylate in corneal perforations","volume":"110","author":"Sharma","year":"2003","journal-title":"Ophthalmology"},{"key":"R5-20260508","doi-asserted-by":"crossref","first-page":"1326","DOI":"10.1097\/ICO.0b013e31829cb625","article-title":"Scleral Patch Graft Augmented cyanoacrylate tissue adhesive for treatment of moderate-sized noninfectious corneal perforations (3.5-4.5 mm)","volume":"32","author":"Sharma","year":"2013","journal-title":"Cornea"},{"key":"R6-20260508","doi-asserted-by":"crossref","first-page":"69","DOI":"10.4103\/ijo.IJO_2258_19","article-title":"Intracorneal scleral patch supported cyanoacrylate application for corneal perforations secondary to rheumatoid arthritis","volume":"69","author":"Sharma","year":"2021","journal-title":"Indian J Ophthalmol"},{"key":"R7-20260508","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1159\/000521198","article-title":"Deep anterior lamellar keratoplasty and peripheral lamellar Keratoplasty for a case of severe peripheral ulcerative keratitis","volume":"13","author":"Yokoyama","year":"2022","journal-title":"Case Rep Ophthalmol"},{"key":"R8-20260508","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1016\/j.survophthal.2018.06.002","article-title":"Surgical management of peripheral corneal thinning disorders","volume":"64","author":"Lohchab","year":"2019","journal-title":"Surv Ophthalmol"},{"key":"R9-20260508","doi-asserted-by":"crossref","first-page":"132","DOI":"10.3341\/kjo.2011.25.2.132","article-title":"Tectonic deep anterior lamellar keratoplasty in impending corneal perforation using cryopreserved cornea","volume":"25","author":"Jang","year":"2011","journal-title":"Korean J Ophthalmol"},{"key":"R10-20260508","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1097\/00003226-200003000-00002","article-title":"Lamellar corneal patch grafts in the management of corneal melting","volume":"19","author":"Soong","year":"2000","journal-title":"Cornea"},{"key":"R11-20260508","doi-asserted-by":"crossref","first-page":"3547","DOI":"10.2147\/OPTH.S385782","article-title":"Surgical management of peripheral ulcerative keratitis: Update on surgical techniques and their outcome","volume":"16","author":"Sabhapandit","year":"2022","journal-title":"Clin Ophthalmol"}],"container-title":["Indian Journal of Ophthalmology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/IJO.IJO_964_23","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T13:22:08Z","timestamp":1787836928000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/IJO.IJO_964_23"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,12,22]]},"references-count":11,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2024]]}},"URL":"https:\/\/doi.org\/10.4103\/ijo.ijo_964_23","relation":{},"ISSN":["0301-4738","1998-3689"],"issn-type":[{"value":"0301-4738","type":"print"},{"value":"1998-3689","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,12,22]]},"assertion":[{"value":"2023-04-11","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-09-16","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}