Demographic profile and clinical characteristics of patients presenting with acute ocular burns

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

E-PIX: An enhanced grading for acute ocular burns

An enhanced online and manual grading system, based on the I’s and E’s, for acute ocular chemical injuries is being proposed. E-PIX is designed to be an online/manual grading system that includes all the parameters that adversely affect the outcome of acute chemical injuries. The importance of addressing the I’s and E’s in chemical burns cannot be underestimated. These include the need for the documentation and management of epithelial defect (E), intraocular pressure (P) (IOP), ischemia (scleral) (I), and exposure (X) (acronym - E-PIX). Epithelial defect includes that involving the limbus (L), along with conjunctival (C), corneal (K), and tarsal (T). These additional parameters are graded and represented as an annotation along with the limbal grade providing a comprehensive grading for the injury. A manual entry sheet and a freely accessible online grade generator are a part of the system. The proposed enhanced grading offers a final annotation that provides a clear understanding of all factors that can lead to vision-threatening complications ensuring their assessment and hence subsequently their addressal to improve outcomes, if abnormal. The prognostication continues to be based on the grade of limbal involvement. The additional annotations impact prognosis and outcome if not addressed. Including the laterality of injury provides, in addition, a futuristic understanding of available options. The grade generator retains the flexibility to be dynamic with changes reflecting upon the healing process in the acute stage. The proposed system aims to provide primary and tertiary caregivers alike with a uniform grading system.

Limbal ischemia: Reliability of clinical assessment and implications in the management of ocular burns

Purpose: Limbal ischemia is an important prognostic factor in the management of ocular burns. In this study, we evaluated the reliability of clinically assessing limbal ischemia among ophthalmic professionals. Methods: This study included 111 ophthalmic professionals who were shown 12 diffuse illumination color slit-lamp photographs of eyes with recent chemical injuries. Respondents were asked whether the photos were assessable and if yes, then to indicate the presence, location, and grade of limbal ischemia in each case. The responses were collected using a standard data collection sheet and the inter-observer agreement was calculated. Results: All participants responded to every question. Of the 1,332 responses, images were deemed assessable in 1,222 (91.7%) instances. The overall agreement (Fleiss' kappa) for the presence of limbal ischemia and severity of limbal ischemia was 0.106 and 0.139, respectively (P < 0.012). Among the four groups of observers, practicing cornea specialists displayed significantly (P < 0.003) higher kappa values (0.201–0.203) when compared to residents (0.131–0.185), fellows (0.086–0.127), and optometrists (0.077–0.102). All indicated a poor level of inter-rater consistency. Conclusion: The results indicate that clinical assessment of limbal ischemia is highly subjective and there is lack of reliability even among cornea specialists who regularly manage patients with ocular burns. A non-invasive, standardized, objective, accurate, and reliable modality for ocular surface angiography is desperately needed for proper assessment and prognostication of ocular burns.

Effects of amniotic membrane transplantation combined with limbal stem cell autograft transplantation on ocular burns / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To investigate the effects of amniotic membrane transplantation combined with limbal stem cell autograft transplantation on ocular surface repair time, repair rate and complications in patients with ocular burns. <p>METHODS: The clinical data of each 61 cases(61 eyes)of patients with ocular burns who were treated by limbal stem cell autograft transplantation(control group)or amniotic membrane transplantation combined with limbal stem cell autograft transplantation(observation group)were retrospectively analyzed. The postoperative ocular surface repair rate, repair time, and visual acuity and complications(symblepharon, corneal neovascularization, and keratohelcosis)at 12wk after operation were recorded in the two groups, and the levels of cytokines \〖vascular endothelial growth factor(VEGF), transforming growth factor-β1(TGF-β1), insulin-like growth factor-1(IGF-1)\〗 were compared between the two groups before operation and at 2wk after operation. <p>RESULTS: The postoperative ocular surface repair rate in observation group was higher than that in control group(<i>P</i><0.05)while the repair time was less than that in control group(<i>P</i><0.05). At 12wk after operation, the visual acuity in observation group was significantly better than that in control group(<i>P</i><0.05), and the total incidence rate of postoperative complications in observation group was significantly lower than that in control group(<i>P</i><0.05). At 2wk after operation, the levels of serum VEGF, TGF-β1 and IGF-1 in the two groups were significantly higher than those before operation(<i>P</i><0.05), and the levels in control group were higher than those in observation group(<i>P</i><0.05). <p>CONCLUSION: Amniotic membrane transplantation combined with limbal stem cell autograft transplantation has significant treatment effects on patients with ocular burns, and it can promote ocular surface repair, improve postoperative visual acuity, and can also regulate corneal neovascularization, and it also has positive significance in reducing the risk of postoperative complications.

Caracterización de pacientes con quemaduras corneales / Characterization of patients with corneal burns

Se realizó un estudio observacional, descriptivo y transversal de 150 pacientes con quemaduras de la córnea (en un total de 194 ojos), atendidos en el Cuerpo de Guardia de Oftalmología del Hospital General Docente "Dr. Juan Bruno Zayas Alfonso" de Santiago de Cuba, desde enero hasta diciembre del 2009, a fin de caracterizarles según algunas variables clinicoepidemiológicas. Las lesiones predominaron en el sexo masculino y las edades de 35-44 años, y fueron causadas en su mayoría por radiaciones ultravioletas y álcalis, fundamentalmente en ambientes laborales. El uso de corticoides tópicos en la fase inicial, favoreció la aparición de úlceras corneales; sin embargo, la conducta médica adecuada permitió la evolución favorable en 78,7 % de los afectados. Se recomendó diseñar un programa de intervención educativa en la población, para prevenir estas quemaduras oculares.

An observational, descriptive and cross-sectional study of 150 patients with corneal burns (with a total of 194 eyes), assisted in the Ophthalmology emergency room belonging to "Dr. Juan Bruno Zayas Alfonso" Teaching General Hospital in Santiago de Cuba, was carried out from January to December, 2009, in order to characterize them according to some clinical and epidemiological variables. The lesions prevailed in the male sex and in the 35-44 years age group, and they were caused mostly by ultraviolet radiations and alkali, fundamentally in working environments. The use of topical corticoids in the initial phase, favored the emergence of corneal ulcers; however, the appropriate medical behavior allowed the favorable clinical course in 78,7% of those affected. It was recommended to design a program of educational intervention in the population, to prevent these ocular burns.

Microsurgical treatment for corneoscleral melting in severe ocular burns / 中华显微外科杂志

Objective To evaluate the strategy using cyanoacrylate tissue adhesive (CTA) in amniotic membrane transplantaton(AMT) to manage corneoscleral melting in severe ocular burns. Methods Twelve eyes from eleven patients with chemical or thermal burns of grade Ⅳ were recruited for this study.After medical treatment failed to arrest corneal or sclera melting,CTA were applied directly on the ulcerating corneal or sclera surface to augmented AMT. Results In all cases,all sclera ulcerations (five of eleven) were prevented or healed,epithelialization of burned cornea (eight of eleven) was complete,corneal ulceration in the rest three eyes was successfully arrested. Conclusion Tissue adhesive aided amniotic membrane transplantation is a promising altermnative in managing severe corneoscleral melting in chemical or thermal burns to maintain the integrity of the ocular wall.