Skin burn and ocular damage by calcium oxide (virgin lime) in swines / Queimadura de pele e lesão ocular por óxido de cálcio (cal virgem) em suínos

An outbreak of skin burn and ocular damage by calcium oxide in swines is reported. The outbreak occurred in a rural property located in the municipality of Iuiu, Western Bahia, during the transport of 60 pigs from a recreation farm to a fattening farm. The observed macroscopic lesions were erythematous areas; formation of papules, vesicles, and in some cases, there was the formation of firm, parched, high brown plaques and in other cases detachment and loss of skin. His eyes were dull. Histological analysis of the skin revealed areas of necrosis of focally extensive clotting of the epidermis, and dermis, delimited in the paniculus, by cellular debris and rare neutrophils. Corneal necrosis with perforated ulcer formation, superficial epithelial necrosis, edema, and neutrophil infiltration of the cornea adjacent to the ulcer were revealed in the eye.(AU)

Descreve-se um surto de queimadura de pele e lesão ocular por óxido de cálcio (cal virgem) em suínos. O surto ocorreu em uma propriedade rural localizada no município de Iuiu, região Oeste da Bahia, durante o transporte de 60 suínos de uma granja de recria para uma granja de engorda. Macroscopicamente foi evidenciado que na pele dos suínos havia áreas eritematosas, formação de pápulas, vesículas, e em alguns casos havia a formação de placas elevadas marrom firmes, ressequidas e em outros casos desprendimento e perda da pele. Os olhos estavam opacos. Na microscopia da pele observaram-se áreas de necrose de coagulação focalmente extensa da epiderme, e derme, delimitadas no panículo, por restos celulares e raros neutrófilos. No olho observou-se necrose da córnea com formação de úlcera perfurada, necrose do epitélio superficial, edema e infiltração de neutrófilos na córnea adjacente a úlcera.(AU)

Ulcera escleral secundaria a quemadura química por pila de reloj y cuerpo extraño retenido en fondo de saco conjuntival inferior: caso clínico / Scleral ulcer secondary to chemical burn caused by watch battery and retained foreign body in conjunctival sac inside. Case report

Introducción: Aproximadamente un tercio de las cegueras infantiles son debidas a los traumatismos, siendo la principal causa de déficit visual y ceguera monocular en ninos. caso clínico: Se reporta el caso de un preescolar masculino de 2 años de edad quien presentó úlcera escleral en ojo izquierdo secundaria a quemadura química por pila de reloj cuyo motivo de consulta fue contacto con detergente, con cicatrización dificultosa debido a cuerpo extraño mineral retenido en fondo de saco conjuntival inferior durante aproximadamente un mes, contando desde el ingreso al área pediátrica. conclusión: Se reporta un caso inusual de úlcera escleral. Hasta el momento no se han reportado otros casos de úlcera escleral secundaria a quemadura química por pila de reloj y por objetos retenidos en fondo de saco conjuntival inferior, resaltando el manejo diagnóstico y la demora en la extracción del cuerpo extraño, representando una emergencia oftalmológica.

Introduction: Approximately one-third of childhood blindness is due to trauma, representing the leading cause of visual impairment and monocular blindness in children. case report: The patient is a 2 year old preschool boy, who presented scleral ulcer in his left eye secondary to chemical burn caused by watch battery. The reason for seeking medical care was difficult healing caused by a mineral foreign body retained in the lower conjunctival sac after the patient came in contact with detergent one month before the pediatric consultation. Discussion: An unusual case of scleral ulcer was reported. So far, no other similar cases have been reported. The diagnosis process and the delay for the removal of the foreign body are emphasized in this serious ophthalmologic emergency.

Bovine pericardium in treating large corneal perforation secondary to alkali injury: a case report.

To describe use of a locally processed bovine pericardium (BP) to cover a large central corneal perforation following alkali injury and discuss postoperative outcome. A 27-year-old Malay male patient presented two weeks after alkali splashed in his left eye while working. A clinical diagnosis of left central corneal ulcer with limbal ischemia following alkali injury with secondary infection was made. After failed medical therapy, we performed a Gunderson conjunctival flap under local anesthesia that retracted after one week and resulted in a large central corneal perforation with surrounding stromal thinning. The perforation was covered with a locally processed BP xenograft (Lyolemb) supplied by the National Tissue Bank, University Sains Malaysia. Nine months follow-up showed a well-taken graft without any exposure/dehiscence and minimal inflammation. Amniotic membrane transplantation when used as a patch graft needs an urgent tectonic graft to promote corneal stability in patients with severe corneal thinning. The use of processed BP can be a viable option in treating such cases.

Dose-dependent in vitro inhibition of rabbit corneal matrix metalloproteinases by an extract of Pothomorphe umbellata after alkali injury

The in vitro ability of Pothomorphe umbellata ethanolic crude extract to inhibit matrix metalloproteinase (MMP) in normal cornea and in cornea after alkali injury was demonstrated. Corneas of albino rabbits were injured with 1 N NaOH for 20 s. After 48 h the corneas were excised, homogenized and analyzed for MMP-9 (92 kDa), pro-MMP-2 (72 kDa) and MMP-2 (67 kDa) activity by gelatin zymography. The activity was also measured in untreated corneas. After electrophoresis of 20 æg protein, gels were incubated with 50, 100, or 250 µg/mL lyophilized hydroethanolic (1:1) root crude extract of P. umbellata standardized for 4-nerolidylcatechol (7.09 percent). The activity of the enzymes was compared with that of untreated gel. At 48 h after injury, the activity of all MMPs was increased compared with untreated eyes. When the gels were incubated with P. umbellata extract the activity of MMP-2, pro-MMP-2 and MMP-9 decreased in a dose-dependent manner. MMP-9 activity decreased by approximately 50 percent after incubation with 50 µg/mL and was completely abolished at 100 and 250 µg/mL of the extract. After incubation with 50 µg/mL the activity of pro-MMP-2 and MMP-2 also decreased by 50 percent. The activity of pro-MMP-2 was almost completely abolished after incubation with 250 µg/mL of the extract. For MMP-2 the incubation with 100 or 250 µg/mL of the extract of P. umbellata promoted a 10-fold decrease in activity. In conclusion, P. umbellata root crude extract can be useful as an alternative therapy to control MMP activity after corneal injury.

Expansive mortar-induced ocular injury.

We describe here a case of bilateral chemical injury (with an expansive mortar which is being used in recent times to cut the rocks). On examination limbal ischemia was more in the left eye (9 clock hours) than the right eye (2 clock hours). The case was managed by bilateral removal of foreign bodies, along with conjunctival resection and amniotic membrane transplantation in the left eye. At six-month follow-up, patient had best corrected visual acuity of 20/30 and 20/60 in the right and left eyes respectively. Since this being an occupational hazard, proper eye protection gear should be used by persons using this expansive mortar.

Asian experience with the Pintucci keratoprosthesis.

PURPOSE: To report the outcome of a retrospective study of the Pintucci Biointegrable Keratoprosthesis (PBIKP) in Asian eyes. MATERIALS AND METHODS: This was a retrospective analysis of 31 eyes of 31 consecutive patients, who underwent surgery with implantation of the PBIKP. The age ranged from 7 years to 65 years, with a mean age of 34 years. The indications for the PBIKP were chemical burns (11 cases); highly vascularized failed grafts (11 cases); severe dry eyes with total vascularized cornea (6 cases); miscellaneous (3 cases). Twenty eight bilaterally blind Asian patients, with vision not exceeding hand motion close to face in the better eye, underwent the classical two-stage procedure to implant the PBIKP. In another three patients, the PBIKP was implanted as a one-stage procedure. All 31 eyes were unsuitable for keratoplasty or had repeated failed keratoplasties. All patients were followed up for periods ranging from 6 months to 7 years, with a mean of 3.2 years. RESULTS: No eye had infection or retro prosthetic membrane, which were common complications in other Keratoprostheses designs. Twenty-four of 31 eyes improved to greater than finger counting at 1.5 metres, enabling the patients to function independently. Four of 31 eyes (13%) improved to 20/200 or better. Twelve of 31 eyes had significant complications. However only a few were vision- threatening. CONCLUSION: With careful patient selection, the PBIKP could prove to be a useful modality of treatment for bilaterally corneally blind Asian patients, whose vision cannot be improved with conventional medical or surgical treatments.

Phacoemulsification after penetrating keratoplasty with autologous limbal transplant and amniotic membrane transplant in chemical burns.

We report a patient who had earlier penetrating keratoplasty with amniotic membrane transplant and autologous limbal cell transplant for chemical injury who underwent cataract surgery by phacoaspiration. A posterior limbal incision with corneal valve was made superotemporally with extreme caution to avoid damage to the limbal graft. Aspiration flow rates and vacuum were kept low to avoid any turbulence during surgery. A 6.0 mm optic diameter acrylic foldable intraocular lens was inserted in the bag. The patient achieved a best-corrected visual acuity of 6/12 at 10 months' follow-up with a clear corneal graft. We conclude that caution during wound construction and phacoaspiration can help preserve corneal and limbal graft integrity in patients undergoing cataract surgery after corneal graft and limbal transplantation.

Early results of penetrating keratoplasty following limbal stem cell transplantation.

PURPOSE: To describe the early results of penetrating keratoplasty (PKP) in patients who had earlier received limbal transplantation (LT). METHODS: Prospective, non-comparative interventional case series comprising of four patients with limbal stem cell deficiency (LSCD) due to chemical injury (Cases 1, 2, 4) and xeroderma pigmentosum (Case 3). Cadaveric kerato-limbal allografts or living-related conjunctival-limbal allografts were done in four eyes followed by PKP for visual rehabilitation 3-4.5 months later. The following details were noted: demographics, primary aetiology, type of limbal transplant (cadaveric or living-related), immunosuppression, vision and ocular surface stability before and after LT and PKP, surgical complications and outcome of PKP. RESULTS: Three eyes received living-related conjunctival-limbal allotransplantation and one received cadaveric kerato-limbal allograft. Duration of follow up after PKP ranged from 4 to 11 months. Visual acuity improved in the early postoperative period in all patients but reduced in 2 due to endothelial rejection and after trans-scleral cyclophotocoagulation for medically uncontrolled glaucoma. The ocular surface remained stable in all patients. All patients were started on immunosuppression on the first postoperative day. This was continued till the last follow-up visit. Post-PKP complications were punctate epithelial keratopathy, corneal allograft rejection and secondary glaucoma (one patient each). CONCLUSION: Satisfactory visual rehabilitation is possible after PKP following LT without compromising ocular surface stability. However, a prolonged and close follow-up is warranted to avert complications.

Injeção subconjuntival de soro autógeno no tratamento de queimadura ocular por álcali em coelhos / Subconjunctival injection of autogenous blood in the treatment of ocular alcali burn in rabbits

OBJETIVO: Estudar a ação da injeção subconjuntival de soro autógeno na evolução das complicações, após queimadura ocular grave por álcali induzida experimentalmente em coelhos. MÉTODOS: Foram utilizados trinta olhos de coelhos da raça Nova Zelândia, divididos em dois grupos, de 15 coelhos cada, ambos submetidos à queimadura grave por álcali. Em 15 olhos (grupo tratado), efetuamos, imediatamente após a queimadura, injeção de soro autógeno subconjuntival. Os resultados foram avaliados e comparados logo após a queimadura e nos dias 1, 3, 7, 15 e 30 por meio de ectoscopia biomicroscopia ocular. RESULTADOS: O grupo tratado apresentou melhor resposta de reepitelização da córnea, na fase inicial do processo do que o grupo controle (grupo sem soro autógeno), diferença esta estaticamente significante, assim como resultado final com um menor número de complicações. CONCLUSAO: Os resultados obtidos neste estudo experimental sugerem que soro autógeno pode ter efeito no processo de cicatrização dos olhos após queimadura alcalina, diminuindo complicações tardias e melhorando o prognóstico quanto à estabilidade do processo inflamatório cicatricial.

Açäo tóoica do aloe vera na córnea após queimadura química por álcali-estudo experimental em ratos / The topic effect of aloe vera on the cornea after chemical burn by alkali. An experimental study in rats

Objetivo: Avaliar o efeito tópico do aloe vera na evoluçäo da cicatrizaçäo corneana após trauma químico por álcali. Local: Fundaçäo Altino Ventura, Recife, Pernambuco, Brasil. Método: Foram feitas lesöes nas córneas de oito ratos Wistar e separados, aleatoriamente, em dois grupos de quatro. No primeiro grupo foi aplicado a Aloe vera e no segundo a soluçäo controle por trêes dias. Em seguida, com a lâmpada de fenda, foi aferido o tamanho da lesäo imediatamente após a infúria e às 06, 24, 48 e 54 horas seguintes. Ao final do terceiro dia os animais foram sacrificados e os globos oculares enviados para análise histopatológica. Resultados: O tempo de cicatrizaçäo para o grupo que usou a aloe vera foi, embora superios ao grupo controle, näo significante; além disso, observou-se uma reduçäo no processo inflamatório agudo após o uso da substância investigada. Conclusäo: A aplicaçäo tópica o aloe vera propiciou uma reduçäo discreta do tempo de cicatrizaçäo e uma melhora do processo inflamatório em queimaduras químicas por álcali na córnea

Alkali burns: Report of two cases

We report two cases of alkali burn, one sustained 100% total body surface area [TBSA] burn due to immersion in caustic soda in an unusual manner, and another had a minor burn due to splash while rescuing his colleague from the tank. Their high morbidity and mortality is further increased due to associated inhalation and ingestion of the chemical agent due to immersion. Ocular burn with corneal opacity is another problem one finds in such injuries. Our patient with 100% TBSA burn with eyes and respiratory tract involvement rapidly deteriorated, and died 76 hours post burn. The other patient with the minor burn made a good recovery and healed following surgical excision

Lesiones endoteliales en quemaduras corneales / Endothelial injuries in corneal burnings

Las quemaduras corneales pueden presentarse por varios agentes químicos tanto ácidos como alcalinos o por agentes térmicos, las lesiones microscópicas se pueden valorar por los signos clínicos y la clasificiación de Huges-Roper-Hall, pero las lesiones microscópicas de los tejidos, en especial del endotelio corneal, no son valorables por este medio, por lo que la microscopía especular sería muy útil en estos casos. Se incluyeron a todos los pacientes con quemaduras unioculares, se les realizó microscopía especular en ambos ojos y se relacionó el grado de quemadura con las alteraciones endoteliales encontradas. Los cambios celulares encontrados fueron disminución de la densidad celular que es directamente proporcional a la disminución del porcentaje de hexagonalidad y esto a su vez presentó un agrandamiento celular y espacios intercelulares amplios

Quemaduras químicas oculares vs. delincuencia / Oculars chemical burns vs. delinquency

Se trata de la presentación de ocho casos evaluados en la emergencia de la Clínica El Ávila, Caracas, Venezuela, quienes consultaron tras haber sido sometidos a un acto agresivo o violento al arrojarles una sustancia irritante (ácidos, alcalis u otros) en uno o ambos ojos con intención delictiva. De ellos sufren la sintomatología completa de las quemaduras graves por álcalis, transformándose en incapacitados visuales en la etapa más productiva de su vida con las consecuencias que esto tráe. De allí la motivación para la prevención de este tipo de acciones en nuestro medio

Conjunctival transplantation for corneal surface reconstruction--case reports and review of literature.

Corneal persistent epithelial defects (PED) can occur due to various causes. In diffuse ocular surface disease, they often occur secondary to depletion of limbal stem cells. A number of complications occur secondary to PED and successful treatment usually requires conjunctival surgeries for corneal surface reconstruction. We report two cases of chemical injury successfully treated by two such procedures. This report highlights the encouraging results of limbal transplantation and reviews the literature in the management of PED with limbal stem cell loss.

Avances en causticaciones / Advances in chemical burns

El entendimiento en profundidad de los diferentes mecanismos de daño, defensa y reparación que toman lugar en una causticación ocular, ha permitido tratar en mejor forma a estos pacientes. En la etapa aguda, la medida más importante continúa siendo la irrigación profusa del ojo en el mismo lugar del accidente. Lisis de adherencias, antibióticos, corticoides, hipotensores y citrato de sodio deben emplearse. En la etapa subaguda nuestro norte será promover la epitelización (lente de contacto blanda terapéutica, tarsorrafía) y, evitar y tratar la ulceración. En la etapa tardía deberemos tratar las complicaciones y uno de los procedimientos empleados es la rehabilitación de la superficie ocular, con el transplante de células epiteliales sanas; puede hacerse tan precozmente como cuatro semanas despúes de la causticación, siempre que la isquemia limbar haya pasado y el limbo se encuentre vascularizado

Effect of topically applied Na-hyaluronan on experimental corneal alkali wound healing

The effect of topically applied 1% sodium hyaluronate (Na-HA) on the healing of a standardized corneal alkali wound was studied. The healing of the epithelium, stroma, and endothelium was evaluated separately, using quantitative methods. Central corneal alkali wound was produced in one eye of the rabbits by applying a 5.5-mm round filter paper, soaked in 1 N NaOH, for 60 seconds. 1% Na-HA in the treatment group and phosphate buffered saline (PBS) in the control group were given topically 4 times per day for 2 days, 1- and 3-weeks. Epithelial and endothelial healing was assessed morphometrically from standardized photographs and micrographs, respectively. Stromal healing was determined by counting polymorphonuclear leukocytes (PMN) and keratocytes in the central and marginal wound areas. A positive healing influence was observed in the epithelium. In stromal healing, 1% Na-HA treated corneas showed less PMNs and more keratocytes than the control group, suggesting that topically applied 1% Na-HA may suppress the stromal PMN infiltration and enhance the keratocyte repopulation during corneal alkali wound healing. However, no significant difference was found in morphometric evaluation of endothelial healing between the two groups.

Traumatismos oculares / Eye injuries

O trauma ocular ocupa lugar proeminente na infortunística médica, representando assunto vasto e destacado no estudo da oftalmologia.O presente trabalho faz uma revisao das lesoes traumáticas mais prevalentes, salientando os aspectos clínicos, propedêuticos e terapêuticos mais importantes.Enfase especial é dada aos avanços cirúrgicos que vieram modificar de forma significativa o prognóstico e a recuperaçao funcional de olhos extensamente lesados, no tratamento dos traumatismos do pólo posterior.

Endothelial F-actin changes in the alkali burned rabbit cornea

The healing mechanism of corneal endothelium after alkali burn was not completely understood. Rabbit cornea was burned with 1N sodium hydxoside for 1 minute. Endothelial F-actin was stained with NBD-phallacidin in regular sequence to find out the details of endothelial healing after alkali burn. F-actin was completely destroyed leaving a sharp margin against the unaffected area 1 hour after the burn. In the 3, 5 and 7 day specimens, highly active F-actin reactions were noted at the wound margin. New multiple F-actin layers, arising from the intact endothelium near the wound margin, were noted in the 9 day specimen. In the 8 1/2 month specimen, the endothelial defected area was covered by large primitive cells, each of which showed F-actin fiber bundles in the cytoplasm with a large nuclear shadow. Nearly all of the large primitive cells showed F-actin fibers arranged in shapes of cell junctions. Twelve months after the burn, endothelial defects were not found. Nearly all of the endothelial cells were normal in size and shape except for some mushroom-like projections toward the anterior chamber in some areas. Nineteen months after the burn, the endothelial cells were normal. Endothelial wound healing process can be continued even 1 year after the alkali burn in rabbit cornea.