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Purpose: To describe the outcomes of eyes with calcium carbide (CaC2)?related thermo?chemical injury. Methods: This study included 28 eyes of 23 patients who presented with calcium carbide?related ocular burns. Only patients with more than three months of follow?up were included. Group A included 16 eyes with Dua抯 Grade I朓II burns, while Group B included 12 eyes with Grade IV朧I burns. Electronic medical records were reviewed to provide data on the etiology of burn, presenting clinical signs and visual acuity, sequelae, and surgical interventions performed, both in the acute and chronic phases. Results: The overall mean age was 28.48 � 11.8 years. Fifteen patients were injured while using carbide to create an explosion to scare away animals on farms. The median presenting BCVA (best?corrected visual acuity) in Group A (20/160) was significantly better than in Group B [(20/2000) (P = 0.002)]. Five eyes in Group A and one eye in Group B underwent medical management. There was no difference in the duration of follow?up for both groups (P = 0.24). The median final BCVA in Group A (20/32) was significantly better than in Group B [(20/200) (P = 0.02)]. Two eyes in Group A and nine eyes in Group B developed LSCD. Two eyes in Group B were phthisical at the last visit. Conclusion: Calcium carbide?related ocular injuries can result in significant visual morbidity in young adults. Early presentation and management may improve outcomes. Prevention of these injuries by increasing awareness and increasing advocacy efforts is necessary.
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Purpose: To evaluate various factors affecting the integrity of human donor corneal epithelium. Methods: Donor corneal buttons were evaluated for epithelial defect (ED) and exposure. The slit?lamp photographs were taken on day 01, and the data such as age and gender of the donor, cause of death, refrigeration of cadavers, death?to?preservation time (DPT), experience of technician, and distance from site of collection to eye bank were collected. Results: A total of 100 consecutive corneal buttons belonging to 56 donors were evaluated. The median age of donors was 50 years. Males constituted 45 (80.4%). The mean DPT was 9.7 ± 5.3 hours. After death, 34 donors (60.7%) were refrigerated before the collection/retrieval. Most of the corneas (80%) were recovered by technicians having an experience of 0–5 years. Thirty?one donors (55.3%) were located at 1–50 km from the eye bank. The mean area of exposure was 15 ± 4.3 mm2. The mean area of ED was 28.7 ± 5.9 mm2. ED was significantly associated with refrigeration of cadavers and longer DPT. On multivariate analysis, only DPT was found to be significantly associated (P = 0.006; odds ratio [OR] = 1.54 ± 0.24) with the presence of ED. After transplantation, only two corneas had persistent epithelial defects and were treated successfully using various interventions. Conclusion: Integrity of donor corneal epithelium is mainly influenced by the refrigeration of cadavers and DPT.
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Purpose: To evaluate the role of McCarey-Kaufman (MK) medium in maintaining the integrity of donor corneal epithelium. Methods: Nineteen corneal buttons were harvested and stored in MK media at 2°C–8°C for four days. Serial photographs were done every day till the 3rd day, and images were then analyzed with ImageJ software (LOCI, University of Wisconsin, USA). The area of exposure and epithelial defect (ED) was calculated every day for each corneal button. Results: The average age of the donors was 56.5 ± 22.7 years and mean time from death to preservation of the corneal buttons was 7.7 ± 3.1 hours. The average corneal area was 145.6 ± 18.8 mm2. The total mean area of exposure was 3.6 ± 4.8, 7.2 ± 9.2, and 9.0 ± 11.9 mm2, and ED was 1.7 ± 4.6, 2.8 ± 5.3, and 3.3 ± 5.9 mm2 on days 1, 2, and 3, respectively. The percentage of increase in the area of exposure and ED in MK media was 3.71% and 1.1% from day 1 to day 3, respectively. Six out of 19 corneal buttons (31.57%) were utilized for keratoplasties, of which two were utilized in house and four were distributed outside. Of the two utilized corneas, none had epithelial defect on postoperative day 1. Rest 13 corneas were either used for training and research purposes, stored in glycerol media, or discarded. Conclusion: Since the percentage change in area of exposure/ED is not much at the end of day 3, corneas stored in MK media can be safely used even after three days of storage. Hence, MK medium serves as an excellent medium in maintaining the integrity of donor corneal epithelium
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Purpose: To analyze the early changes in host and donor lenticule thickness after Descemet Stripping Endothelial Keratoplasty (DSEK). Methods: DSEK was performed on 32 eyes of 31 patients. Pre? and post? operative slit lamp examination and anterior segment Optical Coherence Tomography (OCT) was done on day?1, day?7, 1 month, and 3 months. Results: There were significant changes in host, lenticule, and total corneal thicknesses between day?1 and day?7, and day?7 and 1 month. There were significant changes in host thickness and total corneal thickness between 1 month and 3 months. Thickness changes were significant between day?1 and day?7, and 1 month and 3 months for thick and thin host, respectively, whereas these changes were observed both for thick and thin host between day?7 and 1 month. Similarly, significant changes were observed between day?7 and 1 month, and day?7 and 1 month in thin lenticule whereas in case of thick lenticule, it was observed till the 3 months follow?up period. There was a significant improvement in visual acuity till the 3 months follow?up period. No significant correlation was observed between visual acuity and host and lenticule thickness. Conclusion: The thicknesses of host and lenticule decrease continuously. Lenticule thickness stabilizes before host. Thinner cornea stabilizes earlier compared to thicker cornea
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Purpose: To evaluate the efficacy of voriconazole and amphotericin B in McCarey–Kaufman (MK) media. Methods: MK media vials were supplemented with either voriconazole at 1, 2, 20, 50, 100 ?g/mL or amphotericin B at 0.5, 1, 2, 10, 20 ?g/mL. The standard inoculum of the American Type Culture Collection (ATCC) strain of Candida albicans, Aspergillus flavus, and Fusarium keratinoplasticum was added to the set of vials. The efficacy outcomes were calculated as ‘viable fungal colony counts’ determined from the samples taken on Days 0 and 4. MK media containing fungal inoculum but without antifungal supplements were used as control. Results: In the voriconazole arm, on Day 4, a reduction in the colony count was observed for Candida albicans (1 ?g/mL, 36%; 100 ?g/mL, 100%), Aspergillus flavus (1 ?g/mL, 53.8%; 100 ?g/mL, 80.4%), and Fusarium keratinoplasticum (1 ?g/mL, 39.0%; 100 ?g/mL, 72.2%). Similarly, in the amphotericin B arm, on Day 4, a reduction in the colony count was observed for Candida albicans (0.5 ?g/mL; 99.9%; 20 ?g/mL, 100%), Aspergillus flavus (0.5 ?g/mL, 65.2%; 20 ?g/mL, 84.8%), and Fusarium keratinoplasticum (0.5 ?g/mL, 90.1%; 20 ?g/mL, 100%). Conclusion: Compared to voriconazole, the addition of amphotericin B significantly reduces fungal contamination in MK media.