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Purpose: To study and compare the demographic and clinical profile of acute ocular burns (AOB) in children and adults. Methods: This retrospective case series included 271 children (338 eyes) and 1300 adults (1809 eyes) who presented to two tertiary eye care centers within one month of sustaining AOB. Data regarding demographics, causative agents, severity of injury, visual acuity (VA), and treatment were collected and analyzed. Results: Males were more commonly affected particularly among adults (81% versus 64%, P < 0.00001). Among children, 79% sustained domestic injuries, whereas 59% of adults had work?place injuries (P < 0.0001). Most cases were due to alkali (38%) and acids (22%). Edible lime (chuna, 32%), superglue (14%), and firecrackers (12%) in children, and chuna (7%), insecticides, lye, superglue (6% each), toilet cleaner (4%) and battery acid (3%) in adults, were the main causative agents. The percentage of cases with Dua grade IV?VI was greater in children (16% versus 9%; P = 0.0001). Amniotic membrane grafting and/or tarsorrhaphy were needed in 36% and 14% of affected eyes in children and adults, respectively (P < 0.00001). The median presenting VA was logMAR 0.5 in children and logMAR 0.3 in adults (P = 0.0001), which improved significantly with treatment in both groups (P < 0.0001), but the final VA in eyes with Dua grade IV?VI burns was poorer in children (logMAR 1.3 versus logMAR 0.8, P = 0.04). Conclusion: The findings clearly delineate the at?risk groups, causative agents, clinical severity, and treatment outcomes of AOB. Increased awareness and data?driven targeted preventive strategies are needed to reduce the avoidable ocular morbidity in AOB
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Background: Optic disc pit–associated maculopathy (ODP-M) is a rare presentation in children. Therefore, only a few pediatric cases successfully managed have been reported in the literature. This video shows successful management of ODP-M with human amniotic membrane graft in a pediatric case presenting with recurrence with intraoperative optical coherence tomography (OCT). Purpose: To demonstrate a successful management of ODP-M with human amniotic membrane graft in a pediatric case presenting with recurrence. Synopsis: A 13-year-old patient who had been previously operated with 25-G pars plana vitrectomy with double internal limiting membrane peel and juxtapapillary endolaser with SF 6 gas tamponade for optic disc pit–associated maculopathy (ODP-M) presented with recurrence 9 months after primary surgery. Three 25-G sclerotomies were made and human amniotic membrane graft was tucked into the ODP; the position of the graft was confirmed with intraoperative ocular coherence tomography. Subretinal fluid rapidly resolved within 48 h and best-corrected visual acuity improved to 0.5 logMAR after one week. Later follow-ups showed no complications or recurrence. Highlights: This video shows successful management of ODP-M with human amniotic membrane graft in a pediatric case presenting with recurrence with intraoperative optical coherence tomography (OCT), without any additional tamponade.
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Conjunctival tumors involving non?limbal locations, such as the fornix and canthus, are typically excised using a “non?touch” technique, often with a wide surgical margin. Reconstruction of these large defects can be difficult due to the contour of the ocular surface and are often complicated by shortening of the fornix, symblepharon formation, and restriction of eye movements. In our experience, the use of amniotic membrane grafts combined with the sealant properties of fibrin glue such as Tisseel® has improved our surgical outcomes during the reconstruction phase. We would like to highlight and describe our surgical technique using fibrin glue and squint hooks to aid amniotic membrane graft reconstruction for surgically challenging locations in the fornix and canthus following excision of conjunctival lesions, with excellent surgical outcomes.
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Background: Optic disc pit–associated maculopathy (ODP-M) is a rare presentation in children. Therefore, only a few pediatric cases successfully managed have been reported in the literature. This video shows successful management of ODP-M with human amniotic membrane graft in a pediatric case presenting with recurrence with intraoperative optical coherence tomography (OCT). Purpose: To demonstrate a successful management of ODP-M with human amniotic membrane graft in a pediatric case presenting with recurrence. Synopsis: A 13-year-old patient who had been previously operated with 25-G pars plana vitrectomy with double internal limiting membrane peel and juxtapapillary endolaser with SF 6 gas tamponade for optic disc pit–associated maculopathy (ODP-M) presented with recurrence 9 months after primary surgery. Three 25-G sclerotomies were made and human amniotic membrane graft was tucked into the ODP; the position of the graft was confirmed with intraoperative ocular coherence tomography. Subretinal fluid rapidly resolved within 48 h and best-corrected visual acuity improved to 0.5 logMAR after one week. Later follow-ups showed no complications or recurrence. Highlights: This video shows successful management of ODP-M with human amniotic membrane graft in a pediatric case presenting with recurrence with intraoperative optical coherence tomography (OCT), without any additional tamponade.
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Purpose: To study the changes in corneal astigmatism before and after pterygium excision as well as with differences between various surgical techniques (bare sclera, conjunctival autograft, amniotic membrane graft). Methods: The study population included 71 patients with primary pterygium who underwent surgery. The surgical techniques used differed among the study population. All the patients were preoperatively assessed for visual acuity, anterior and posterior segments, autorefraction, and autokeratometry. After surgery, the patients were assessed for visual acuity, autorefraction, and autokeratometry on day 5, 1 month, and 3 months and the results were analyzed. Paired and unpaired t-tests were used to compare the variables. The probability level of 0.05 was considered as statistically significant. Results: The reduction in the mean preoperative astigmatism of 3.47 ± 1.74 Diopters (D) to 1.10 ± 0.78 D 3 months after surgery was statistically significant (P < 0.0001). Bare sclera, conjunctival autograft, and amniotic membrane graft techniques exhibited changes in astigmatism amounting to 1.85 ± 0.88 D, 2.55 ± 1.26 D, and 2.67 ± 1.44 D, respectively. Pterygium excision surgeries using amniotic membrane graft and conjunctival autograft techniques were more effective than pterygium excision surgery using bare sclera technique in reducing astigmatism. Conclusion: Pterygium excision results in significant reduction in astigmatism which leads to improvement in visual acuity. Amniotic membrane graft and conjunctival autograft are better surgical techniques than bare sclera as far as reducing astigmatism is concerned.
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Purpose: The purpose of this study is to evaluate and compare the effectiveness of conjunctival autograft transplantation andamniotic membrane graft transplantation in pterygium surgery.Materials and Methods: This was a randomized, parallel group, Single-center study included 60 patients. 30 patients ofwhich underwent pterygium excision followed by Conjunctival autograft transplantation. The other 30 patients also underwentpterygium excision with amniotic membrane graft transplantation. Follow-up was done for 6 months to evaluate the post-operativecomplaints, graft integrity, and complications associated with each procedure.Results: Post-operative discomfort and watering were less in amniotic membrane graft group (P = 0.13%). Further, in amnioticmembrane group, there was less transient graft edema (P = 0.22) and conjunctival hyperemia (P = 0.004). However, graft losswas more (P = 0.33) and so was the conjunctival granuloma formation (P = 0.45) in the amniotic membrane group.Conclusion: Amniotic membrane graft is as effective and safe as conjunctival autograft with no major complications.
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PURPOSE: This retrospective observational case series of fifty-one consecutive patients referred to the eye clinic with acute-stage Stevens-Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN) from 1995 to 2011 examines the effect of early treatment with a systemic corticosteroid or intravenous immunoglobulin (IVIG) on the ocular outcomes in patients with SJS or TEN. METHODS: All patients were classified by age (18 years) and analyzed by treatment modality and early intervention with systemic corticosteroids (< or =5 days), IVIG (< or =6 days), or amniotic membrane graft transplantation (AMT) (< or =15 days). The main outcomes were best-corrected visual acuity (BCVA) in logarithm of the minimum angle of resolution (logMAR) and ocular involvement scores (OIS, 0-12), which were calculated based on the presence of superficial punctate keratitis, epithelial defect, conjunctivalization, neovascularization, corneal opacity, keratinization, hyperemia, symblepharon, trichiasis, mucocutaneous junction involvement, meibomian gland involvement, and punctal damage. RESULTS: The mean logMAR and OIS scores at the initial visit were not significantly different in the pediatric group (logMAR = 0.44, OIS = 2.76, n = 17) or the adult group (logMAR = 0.60, OIS = 2.21, n = 34). At the final follow-up, the logMAR and OIS had improved significantly in the adult group (p = 0.0002, p = 0.023, respectively), but not in the pediatric group. Early intervention with IVIG or corticosteroids significantly improved the mean BCVA and OIS in the adult group (p = 0.043 and p = 0.024, respectively for IVIG; p = 0.002 and p = 0.034, respectively for corticosteroid). AMT was found to be associated with a significantly improved BCVA or OIS in the late treatment group or the group with a better initial OIS (p = 0.043 and p = 0.043, respectively for BCVA; p = 0.042 and p = 0.041, respectively for OIS). CONCLUSIONS: Our findings suggest that patients with SJS or TEN who are aged 18 years or less have poorer ocular outcomes than older patients and that early treatment with steroid or immunoglobulin therapy improves ocular outcomes.
Subject(s)
Adolescent , Child , Child, Preschool , Female , Humans , Infant , Male , Acute Disease , Age Factors , Amnion/transplantation , Biopsy , Corneal Diseases/etiology , Follow-Up Studies , Glucocorticoids/administration & dosage , Immunoglobulins, Intravenous/administration & dosage , Retrospective Studies , Stevens-Johnson Syndrome/complications , Time Factors , Treatment Outcome , Visual AcuityABSTRACT
PURPOSE: To investigate the clinical results, recurrence rates, and recurrence-related risk factors of temporary amniotic membrane patch (TAMP) after excision of primary pterygium. METHODS: Recurrence grade was evaluated for 73 eyes with a mean follow-up of 15.5 months (range 9 to 56 months). Surgical results were classified into surgical success (G0/G1), conjunctival recurrence (G2), and corneal recurrence (G3). Recurrence rates were analyzed based on gender, age, Tan's preoperative grading system, horizontal and vertical length of the preoperative pterygium, the corneal involvement size of the preoperative pterygium, planned or unplanned removal of amniotic membrane, and epithelial healing time. Using Kaplan-Meier survival analysis, the cumulative proportion of integrated G0/G1 was evaluated. RESULTS: In the postoperative grading, 58 (79.5%) and 9 (12.3%) eyes were graded as clinically recurrence-free G0 and G1, respectively; 4 (5.5%) and 2 (2.7%) eyes were graded as clinically recurrence-occurred G2 and G3, respectively. The cumulative proportion of integrated recurrence-free G0/G1 at 24 months after surgery was 0.83 +/- 0.08. T3 of Tan's preoperative grading system was identified as the only risk factor for recurrence above G1 through multivariate logistic regression analysis (p = 0.02). CONCLUSIONS: The recurrence rate of the present TAMP study showed better results in comparison with 9.1 to 56.1% of recurrence rates in other studies. The TAMP has advantages of surgical procedure with ease, low complications, and low recurrence rates. Therefore, after surgical excision of primary pterygium, the authors concluded the TAMP is highly recommended for good clinical outcomes and low recurrence rates.
Subject(s)
Amnion , Eye , Follow-Up Studies , Logistic Models , Pterygium , Recurrence , Risk FactorsABSTRACT
PURPOSE: To report a case of alkali burn treated successfully with early surgical intervention including amniotic membrane graft and forniceal reconstructionand the restored visual acuity. CASE SUMMARY: A 23-year-old woman was referred for alkali burn of her right eye after being splashed with a drop of 40% sodium hydroxide. Slit-lamp microscopic examination showed the patient's cornea was edematous, and hazy and limbal ischemia involved half of the cornea, which can supposedly lead to eyelid deformity and symblepharon. Debridement of all necrotic tissues, immediate amniotic membrane permanent graft and transient forniceal covering with amniotic membrane were conducted a day after the burn. Corneal and conjunctival epithelial defects were completely healed in five weeks, and visual acuity was restored to 20/20 in eight weeks. Additional surgeries for allogenic limbal transplantation and autologous oral mucosal graft were performed to resolve symblepharon.
Subject(s)
Female , Humans , Young Adult , Alkalies , Amnion , Burns , Congenital Abnormalities , Cornea , Debridement , Eye , Eyelids , Hydroxides , Ischemia , Sodium Hydroxide , Transplants , Visual AcuityABSTRACT
PURPOSE: We investigated the usefulness of subsequent amniotic membrane transplantation following adhesiolysis in preventing readhesion and improving the results of surgery. METHODS: Primary blepharoplasty was done on both eyelids of 8 albino rabbits. After 2 weeks, a new skin incision was made and adhesiolysis was done on both eyelids. The rabbits were categorized into two groups, one with adhesiolysis alone in left eyelids (control), and the other with adhesiolysis with AM graft in right eyelids (AM graft). In the AM graft group, the 15 x 4-mm sized amniotic membrane was designed and transplanted between tarsal plate, orbicularis muscle and subcutaneous tissue with 8-0 Vicryl suture (4 points). The skin was sutured with 6-0 nylon. The rabbits were sacrificed at 1, 2, 4 and 8 weeks after operation, at which time the change of lid shape, inflammation and fibrosis were evaluated. The degree of inflammatory cell infiltration was examined on H & E stain and Masson-trichrome stain was performed to evaluate the degree of fibrosis. RESULTS: On eyelid examination directly after the operation, lid traction was detected in both groups, but after 1 week, the shape of the eyelids had recovered completely in both groups. At 8 weeks, the control group showed more irregular lid margin and surfaces than AM graft group. In microscpic findings at 2 weeks, the AM graft group showed more inflammatory cell infiltration than the control group. At 4 weeks, amniotic membranes were absorbed and inflammatory cell infiltration decreased in both groups, but the AM graft group showed more inflammation than the control group. At 8 weeks, the two groups had little inflammation but the AM graft group showed less fibrosis than the control group on Masson-trichrome stain. CONCLUSIONS: From these findings, we suggest that the use of amniotic membrane graft after adhesiolysis and blepharoplasty is an effective method for prevention of postoperative adhesion.
Subject(s)
Rabbits , Amnion , Blepharoplasty , Eyelids , Fibrosis , Inflammation , Nylons , Polyglactin 910 , Skin , Subcutaneous Tissue , Sutures , Traction , TransplantsABSTRACT
PURPOSE: To evaluate the clinical effect of amniotic membrane (AM) graft and drainage valve implantation for the treatment of bullous keratopathy combined with intractable glaucoma. METHODS: Total 15 patients (15 eyes) were analyzed who underwent the operation for bullous keratopathy combined with intractable glaucoma, from Feb. 2002 to Aug. 2003. Under retrobulbar anesthesia, Ahmed valve was implanted under the supratemporal conjunctiva and exposed valve was covered with AM. And then, AM graft was performed after lamellar keratectomy for treatment of keratopathy. Serial check of IOP, corneal status and complications were performed after operation and during follow up. RESULTS: Mean IOP at last follow up was 11 mmHg. Corneal epithelium was stabilized within 10days. No serious complication was found and the drainage tube was well positioned. Especially, there is no pain in all cases. CONCLUSIONS: AM graft and valve implantation was clinically effective method for treatment of bullous keratopathy, combined with intractable glaucoma.
Subject(s)
Humans , Amnion , Anesthesia , Conjunctiva , Drainage , Epithelium, Corneal , Follow-Up Studies , Glaucoma , TransplantsABSTRACT
PURPOSE: We reported the surgical efficacy of amniotic membrane graft with cryotherapy, after primary surgical resection of the conjunctival squamous cell carcinoma METHODS: Three cases of conjunctival squamous cell carcinoma were completely resected with two layered cryotherapy along inner and outer side of tumor margin The extensive conjunctival defect was reconstructed with amniotic membrane graft. We evaluated the surgical effect and recurrence of conjunctival squamous cell carcinoma after surgery. RESULTS: Conjunctiva and cornea were completely healed with no recurrence, during the follow up of 8 months, 18 months, and 22 months, respectively. CONCLUSIONS: Surgical excision with adjunctive cryotherapy in peripheral area of the tumor margin and amniotic membrane transplantation could be considered effective method for treatment of conjunctival squamous cell carcinoma.
Subject(s)
Amnion , Carcinoma, Squamous Cell , Conjunctiva , Cornea , Cryotherapy , Follow-Up Studies , Recurrence , TransplantsABSTRACT
PURPOSE: This study was performed to evaluate the effect of amniotic membrane graft on corneal opacity after traumatic penetrating injury. METHODS: Corneal penetrating wound was made, 6mm in length. A total of 60 rabbit eyes were divided into three groups: (1) applied with amniotic membrane (n=20); (2) applied with contact lens (n=20); (3) control (n=20). Corneal opacity was analyzed with photoslit microscopy finding, histopathological finding, and expression of alpha-smooth muscle actin. RESULTS: Grade of corneal opacity was lower in amniotic membrane applied group (p<0.05). Infiltration of the inflammatory cells and expression of alpha-smooth muscle actin were also lower in amniotic membrane applied group. Histological structures of stromal cells were more regular in amniotic membrane applied group. CONCLUSIONS: Amniotic membrane graft can be an effective therapeutic method for prevention of corneal opacity after trauma by inhibiting infiltration of the inflammatory cells, proliferation of stromal cell and wound contracture by fibroblasts.
Subject(s)
Actins , Amnion , Contracture , Corneal Opacity , Fibroblasts , Microscopy , Stromal Cells , Transplants , Wounds and Injuries , Wounds, PenetratingABSTRACT
This study was performed to investigate histopathologically the effect of amniotic membrane graft (AMG)on haze in deep stromal wound of cornea. The excimer laser phototherapeutic keratectomy (PTK)was used to create the wound model of 150 micrometerdepth, 6.0 mmdiameter area in 72 white rabbitsbilaterally.Each eye was randomized to three groups: control (topical antibiotic alone), contact lens application and AMG. Corneal haze,the number of anterior stromal keratocytes and thickness of the regenerated stroma were evaluated after treatments in corneal wound, and also the morphological changes of anterior stroma connected with corneal haze were analyzed. The score of corneal haze in AMG group was significantly lower than those in the others at postoperative 3 days, 2, 4, 6 and 8 weeks. The anterior stromal keratocytes in AMG group significantly remained more than those in the others at postoperative 3 days. The number of keratocytes and thickness of regenerated stromal tissue in wound area of AMG group were statistically lower as compared with those of the other groups at postoperative 4 weeks. The architecture of stromal lamella was most reg-ular in AMG group. Transmission electron microscopic observation demonstrated that the cells in anterior stroma were the active fibroblastic cells with prominent rough endoplasmic reticulum at postoperative 8 weeks. These findings indicate that corneal haze is closely connected with proliferation of corneal stroma , suggesting that AMG on deep corneal stromal wound reduces corneal haze by preventing proliferation of abnormal collagen and fibroblasts at the anterior stroma of the wound area.