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Feizi S, Jafari F, Hooshmandi S, Esfandiari H. Topical erythropoietin for the management of scleral necrosis after ocular chemical burns. Burns 2024; 50:1614-1620. [PMID: 38604821 DOI: 10.1016/j.burns.2024.03.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 01/25/2024] [Accepted: 03/31/2024] [Indexed: 04/13/2024]
Abstract
PURPOSE To evaluate the efficacy of topical erythropoietin for chemical burn induced scleral necrosis. METHODS This study included 18 eyes of 16 patients with chemical burn induced scleral necrosis who presented within 6 weeks of the injury. In the prospective arm, 11 eyes received topical erythropoietin, 3000 IU/mL every 6 h, along with standard medical treatment. Retrospectively, we included 7 consecutive eyes of 7 patients who were managed with conventional treatment as historical control group. The main outcome measure was healing of avascular scleral lesions. The secondary outcome measure was complete re-epithelization of cornea. RESULTS Mean patient age was 39.8 ± 16.2 years in the erythropoietin group, and they presented 16.6 ± 15.2 days after acute chemical injury. Scleral necrosis improved in all eyes after 30.7 ± 23.2 days of treatment with topical erythropoietin. Corneal epithelial defects were completely healed in 10 eyes 61.9 ± 50.7 days after the start of the medication. In comparison, standard medical treatment alone did not improve scleral necrosis in the historical control group, necessitating ocular surface reconstruction including conjunctival advancement (1 eye) and tenonplasty (6 eyes). CONCLUSION The results of our study showed that topical erythropoietin was effective in the management of chemical burn induced scleral necrosis. This treatment could avoid ocular surface reconstruction procedures in inflamed eyes.
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Affiliation(s)
- Sepehr Feizi
- Ocular Tissue Engineering Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Fatema Jafari
- Ocular Tissue Engineering Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sadid Hooshmandi
- Ocular Tissue Engineering Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamed Esfandiari
- Department of Ophthalmology, Olmsted Medical Center, Rochester, MN, USA
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Cronbach N, Foot B, Scawn R. Severe ocular chemical injury in the UK: a British Ophthalmological Surveillance Unit study. Eye (Lond) 2024:10.1038/s41433-024-03073-6. [PMID: 38637697 DOI: 10.1038/s41433-024-03073-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 03/14/2024] [Accepted: 04/05/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND Severe ocular chemical injury is a potentially devastating condition which most commonly affects men of working age. Workplace injuries previously accounted for the majority of incidents, but there has been a recent increase in assaults involving corrosive substances throughout the UK. The objectives of this study were to determine the incidence and demographics of severe ocular chemical injury and describe current surgical management practices. METHODS Cases were prospectively ascertained through the British Ophthalmological Surveillance Unit monthly reporting system during 2019-21. In total, 20 cases involving 29 eyes met the inclusion criteria. RESULTS The reported incidence of severe ocular chemical injury during the pre-pandemic period of the study was 0.24 per million. Cases due to alleged assault have become more common than workplace injuries. A total of 81% patients had persistent complications at 6 months requiring ongoing treatment, and 60% patients required surgical intervention. CONCLUSION Although there are limitations with the case ascertainment methods, severe ocular chemical injury remains rare within the UK. There has been a proportionate increase in cases related to alleged assault compared with previous similar studies. Amniotic membrane grafting remains the most commonly performed surgical procedure in these patients.
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Affiliation(s)
- Nicola Cronbach
- Ophthalmology Department, Stoke Mandeville Hospital, Buckinghamshire Healthcare NHS Trust, Aylesbury, UK.
| | - Barny Foot
- Royal College of Ophthalmologists, London, UK
| | - Richard Scawn
- Ophthalmology and Oculoplastic Department, Chelsea & Westminster Hospital, London, UK
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Allen NE, Crawford AZ, McGhee CNJ, Meyer JJ. Chemical eye injuries: a 10 year retrospective review of acute presentations and clinical outcomes in Auckland, New Zealand. Sci Rep 2024; 14:8264. [PMID: 38594410 PMCID: PMC11004117 DOI: 10.1038/s41598-024-58670-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 04/02/2024] [Indexed: 04/11/2024] Open
Abstract
To assess the aetiologies, clinical characteristics, treatment regimens, and outcomes of acute chemical injuries treated at an emergency eye clinic. Retrospective, observational study of all cases of chemical eye injury that presented acutely to the Greenlane Clinical Centre in Auckland, New Zealand from 1 January 2012 through 31 December 2021. Patient demographics, activity at the time of injury, causative chemical, clinical characteristics of injury at presentation, severity (Dua) classification, admission and discharge best corrected visual acuity (BCVA), treatment regimen, time to epithelisation and number of follow-up appointments were recorded. In total, 1522 cases involving 1919 eyes were studied. The mean age was 40.6 ± 18.8 years and 65% were male. The majority of cases occurred at home (62%) and cleaning was the most common activity (38%). There were 1490 Grade I (98%), 22 Grade II (1.5%), 5 Grade III (0.3%), 1 Grade IV (0.07%), 0 Grade V, and 4 Grade VI (0.3%) cases. An epithelial defect was noted in 409 cases (26.9%), of which re-epithelialisation occurred within one week for 378 cases (92%) and within 30 days for 384 cases (94%). Moderate vision loss (BCVA ≤ 6/12) attributed to the injury occurred in 152 (10%), while severe vision loss (BCVA ≤ 6/60) occurred in 30 (2%). Lack of irrigation at the scene was associated with an increased risk of severe injury and longstanding visual impairment (p = 0.0001). Most acute chemical injuries are mild with good clinical outcomes. Although rare, severe injuries are associated with a lack of irrigation at the scene and worse visual outcomes.
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Affiliation(s)
- Natalie E Allen
- Department of Ophthalmology, The University of Auckland, Auckland, New Zealand.
| | | | - Charles N J McGhee
- Department of Ophthalmology, The University of Auckland, Auckland, New Zealand
| | - Jay J Meyer
- Department of Ophthalmology, The University of Auckland, Auckland, New Zealand
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Heichel J, Huth A, Viestenz A, Struck HG. Augenverätzungen. Klin Monbl Augenheilkd 2024; 241:575-591. [PMID: 38412997 DOI: 10.1055/a-2255-5970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
Chemical burns of the ocular surface (CBOS) are emergencies of highest urgency. Therefore, an adequate emergency care is mandatory. Following a precise analysis of the initial damage, a staged therapeutic approach is used to prevent persistent impairment of the ocular surface. In the acute stage, the prevention of complications is targeted (symblepharon, conjunctival scarring, lacrimal stenosis, corneal ulceration, intraocular inflammation, elevated intraocular pressure, etc.). In later stages, if complications have developed, a secondary restoration of the ocular surface is focussed. Sometimes this requires several surgical interventions. Based on a review of international literature, this review highlights the pathophysiology according to different chemical agents, CBOS stages as well as main therapy strategies in early and advanced stages of CBOS. Acute treatment aims to lower inflammation, oxidative stress and tries to promote reepithelialisation. Besides conjunctival scarring, loss of goblet cells and corneal opacification a limbal stem cell insufficiency is the most harming complication. Several new techniques have been developed to recover the ocular surface with a sufficient and clear epithelial layer in order to avoid neovascularization of the cornea. The knowledge concerning the high risk potential for persistent visual impairment in CBOS patients and the ability for appropriate emergency care should be kept in every physician's mind dealing with CBOS.
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Malepati N, Sharma S, Kate A, Basu S, Shanbhag SS. Clinical profile and management of ocular superglue injuries: Case series and review of literature. Indian J Ophthalmol 2024; 72:587-591. [PMID: 38324204 PMCID: PMC11149532 DOI: 10.4103/ijo.ijo_2541_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 11/21/2023] [Indexed: 02/08/2024] Open
Abstract
PURPOSE To describe the clinical profile and management of patients with ocular superglue injury (OSI). METHODS This retrospective study included all patients with OSI who presented at a tertiary eye care institute between 2016 and 2020. Data regarding demographics, clinical profile, and management were collected. RESULTS A total of 66 eyes of 58 patients (24 children, 34 adults) with a median age of 22.5 years [interquartile range (IQR): 11.3-31] were included. All cases sustained accidental injuries, with domestic injury at home being the most common location of injury among children (79%) and adults (53%) ( P = 0.39). The median visual acuity at presentation was worse in children [0.3 logMAR (IQR: 0.2-0.4)] as compared to adults [0.1 logMAR (IQR: 0.1-0.3)] ( P = 0.03)]. The most common clinical sign at presentation was conjunctival congestion in 77% of eyes (51/66) followed by polymerized glue stuck to the eyelashes and eyelids in 52% of eyes (34/66). The median duration from the time of injury to presentation was 2 hours in both groups. All eyes resolved with medical management. Examination under anesthesia was required in three children (13%) to evaluate the extent of OSI. None of the patients had long-term ocular complications. CONCLUSION Improper and careless handling of superglue in the domestic setting may cause accidental ocular injuries that require immediate medical attention. OSI represents less severe ocular injuries that respond to medical therapy alone and is not associated with long-term visual morbidity. Modifications in the packaging of superglue containers and awareness about their deleterious effects could prevent these injuries.
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Affiliation(s)
- Nikhila Malepati
- Shantilal Shanghvi Cornea Institute, L V Prasad Eye Institute, Hyderabad, Telangana, India
- Academy for Eye Care Education, LV Prasad Eye Institute, Hyderabad, India
| | - Supriya Sharma
- Shantilal Shanghvi Cornea Institute, L V Prasad Eye Institute, Hyderabad, Telangana, India
- Cornea and Anterior Segment Services, Shantilal Shanghvi Eye Institute, Mumbai, Maharashtra, India
| | - Anahita Kate
- Shantilal Shanghvi Cornea Institute, L V Prasad Eye Institute, Vijayawada, Andhra Pradesh, India
| | - Sayan Basu
- Shantilal Shanghvi Cornea Institute, L V Prasad Eye Institute, Hyderabad, Telangana, India
- Centre for Ocular Regeneration (CORE), L V Prasad Eye Institute, Hyderabad, Telangana, India
- Brien Holden Eye Research Centre (BHERC), L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Swapna S Shanbhag
- Shantilal Shanghvi Cornea Institute, L V Prasad Eye Institute, Hyderabad, Telangana, India
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Bian Y, Jurkunas U. Ocular Chemical Injuries and Limbal Stem Cell Deficiency (LSCD): An Update on Management. Int Ophthalmol Clin 2024; 64:31-48. [PMID: 38525980 DOI: 10.1097/iio.0000000000000487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
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7
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Bartimote C, Hoskin AK, Fraser CL, Watson S. Burn related globe and adnexal trauma at trauma centres. Burns 2024; 50:517-523. [PMID: 38097442 DOI: 10.1016/j.burns.2023.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 07/30/2023] [Accepted: 08/15/2023] [Indexed: 02/24/2024]
Abstract
INTRODUCTION Prompt management of burn-related globe trauma can prevent long term complications. Delays in diagnosis may occur when globe trauma is associated with life-threatening injuries. We aimed to improve the understanding of the epidemiology, acute assessment and management of burns-related globe and adnexal trauma admitted to two trauma centres in Sydney, Australia. METHOD Admitted patients with burns-related globe and/or adnexal trauma were retrospectively reviewed at Royal North Shore Hospital (RNSH) and Royal Prince Alfred Hospital (RPAH) between January 2015 and December 2019. The International Classification of Disease, Tenth Revision codes was used to search and identify patients. Medical records were reviewed to extract data on demographics, injuries, ocular examination and ophthalmology involvement. RESULTS Over the 5-years, 101 patients with globe and/or adnexal burns-related trauma were admitted to RNSH or RPAH. Median age was 37years. Most patients were male (76%) and were injured while at home or work (74%). Patients with chemical exposure were more likely to have globe trauma (100% vs 72%, p < 0.001) and severe globe trauma (54% vs 32%, p = 0.028). On initial review by emergency staff, 14 patients were not referred to ophthalmology, of these there were 2 patients where the diagnosis was delayed. CONCLUSION Globe trauma is common in patients with chemical exposure. Thorough ocular assessment within the acute setting is vital to diagnose globe trauma. We investigated hospitals with specialised burn staff, further research is required to understand the management of globe trauma in hospitals without such resources. SYNOPSIS Chemicals in household-products can cause severe globe trauma. Globe trauma can occur alongside large burns leading to delay in its diagnosis and management. Ophthalmology can assist in the early diagnosis and management of globe trauma.
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Affiliation(s)
- Christopher Bartimote
- Ophthalmology, The Sydney and Sydney Eye Hospital, Sydney, Australia; Save Sight Institute, The University of Sydney, Sydney, Australia.
| | - Annette K Hoskin
- Ophthalmology, University of Western Australia, Nedlands, WA, Australia; Save Sight Institute, The University of Sydney, Sydney, Australia
| | - Clare L Fraser
- Ophthalmology, The Sydney and Sydney Eye Hospital, Sydney, Australia; Save Sight Institute, The University of Sydney, Sydney, Australia
| | - Stephanie Watson
- Ophthalmology, The Sydney and Sydney Eye Hospital, Sydney, Australia; Save Sight Institute, The University of Sydney, Sydney, Australia
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Sanders FWB, Huang J, Alió Del Barrio JL, Hamada S, McAlinden C. Amniotic membrane transplantation: structural and biological properties, tissue preparation, application and clinical indications. Eye (Lond) 2024; 38:668-679. [PMID: 37875701 PMCID: PMC10920809 DOI: 10.1038/s41433-023-02777-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 07/20/2023] [Accepted: 09/25/2023] [Indexed: 10/26/2023] Open
Abstract
The amniotic membrane is a single epithelial layer of the placenta. It has anti-inflammatory, anti-scarring, anti-angiogenic and possibly bactericidal properties. The basement membrane of the amniotic membrane acts as a substrate to encourage healing and re-epithelialisation. It has been used in many ocular surface diseases including persistent epithelial defects (corneal or conjunctival), chemical or thermal burns, limbal stem cell deficiency, cicatrising conjunctivitis, ocular graft versus host disease, microbial keratitis, corneal perforation, bullous keratopathy, dry eye disease, corneal haze following refractive surgery and cross-linking, band keratopathy, ocular surface neoplasia, pterygium surgery, and ligneous conjunctivitis. This review provides an up-to-date overview of amniotic membrane transplantation including the structural and biological properties, preparation and application, clinical indications, and commercially available products.
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Affiliation(s)
- Francis W B Sanders
- Department of Ophthalmology, Singleton Hospital, Swansea Bay University Health Board, Swansea, UK
| | - Jinhai Huang
- Eye and ENT Hospital, Fudan University, Shanghai, China
| | - Jorge L Alió Del Barrio
- Division of Ophthalmology, School of Medicine, Universidad Miguel Hernández, Alicante, Spain; and Cornea, Cataract and Refractive Surgery Department, VISSUM Corporation, Alicante, Spain
| | - Samer Hamada
- Corneo Plastic Unit and Eye Bank, Queen Victoria Hospital, East Grinstead, UK
| | - Colm McAlinden
- Eye and ENT Hospital, Fudan University, Shanghai, China.
- Corneo Plastic Unit and Eye Bank, Queen Victoria Hospital, East Grinstead, UK.
- School of Optometry and Vision Sciences, Cardiff University, Maindy Road, Cardiff, UK.
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9
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Kim H, Cho KJ. The effect of photobiomodulation with 830-nm LED on corneal alkali burnt rat model. Lasers Med Sci 2024; 39:81. [PMID: 38418619 DOI: 10.1007/s10103-024-04003-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 01/22/2024] [Indexed: 03/02/2024]
Affiliation(s)
- Hoon Kim
- Department of Ophthalmology, College of Medicine, Dankook University, Cheonan, 31116, Korea
| | - Kyong-Jin Cho
- Department of Ophthalmology, College of Medicine, Dankook University, Cheonan, 31116, Korea.
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10
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Singla E, Jha UP, Muralidharan S, Singh RB, Ichhpujani P. Management of multi-surface ocular burns caused by molten iron. Trauma Case Rep 2023; 48:100925. [PMID: 37727312 PMCID: PMC10505692 DOI: 10.1016/j.tcr.2023.100925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2023] [Indexed: 09/21/2023] Open
Abstract
Ocular thermal burns are medical emergencies that require immediate intervention before the standard management protocol, which involves obtaining a detailed history and performing an ophthalmic examination. In this case report, we report the clinical manifestations of ocular burns caused by molten iron and the steps taken for good clinical outcomes. The patient presented with an inferior epithelial defect and limbal and lower lid ischemia at four hours post-injury. Over the course of treatment, due to non-resolving epithelial defect and increased superior lid notching, amniotic membrane transplantation (AMT) and lid repair by pentagon wedge excision were performed. Following AMT, the corneal surface completely healed with residual opacity and neovascularization. Additionally, limbal ischemia was significantly reduced with the restoration of normal lid anatomy. Corneal burns initiate a cascade of inflammatory reactions disrupting the balance between pro- and anti-angiogenic factors, leading to corneal neovascularization. The eyelid damage can lead to necrosis of tissues with eschar formation and eventually quantitative tissue loss. Therefore, timely intervention is the key to the successful management of ocular burns.
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Affiliation(s)
- Ekta Singla
- Department of Ophthalmology, Government Medical College and Hospital, Chandigarh, India
| | - Ujjwal Prakash Jha
- Department of Ophthalmology, Government Medical College and Hospital, Chandigarh, India
| | - Shruti Muralidharan
- Department of Ophthalmology, Government Medical College and Hospital, Chandigarh, India
| | - Rohan Bir Singh
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, USA
- Department of Ophthalmology, Leiden University Medical Center, 2333ZA Leiden, the Netherlands
| | - Parul Ichhpujani
- Department of Ophthalmology, Government Medical College and Hospital, Chandigarh, India
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Li YT, Wu WY, Li JY, Chan SY, Ang M, Feng Y. Types of Descemet Membrane Detachment After Ocular Surface Burns: The Factor Long Been Ignored. Cornea 2023; 42:1426-1431. [PMID: 36729715 PMCID: PMC10538613 DOI: 10.1097/ico.0000000000003210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 10/19/2022] [Accepted: 10/24/2022] [Indexed: 02/03/2023]
Abstract
PURPOSE The aim of this study was to explore types of Descemet membrane detachment (DMD) after ocular surface burns by anterior segment optical coherence tomography. METHODS This is a pilot, case series, observational study. Patients with DMD after ocular surface burns were enrolled. Ophthalmologic examinations were performed in all patients including slit-lamp photography and anterior segment optical coherence tomography. RESULTS Three types of DMDs in 9 eyes of 9 patients with ocular surface burns were identified depending on the detachment components involved with the pre-Descemet layer (PDL). Type A was referred as a taut chord that the PDL and Descemet membrane (DM) detached simultaneously but were remained attached to each other, while type B was identified as a wavy line separated from the stroma by a dark slit that demonstrated the detachment of DM from the PDL and stroma. Type C was defined as the DM detached with or without PDL but they were separated from each other. We found that DM and PDL were detached simultaneously in most condition, with type A in 4 cases, type C in 5 cases, and type B in only 1 case. CONCLUSIONS Our study demonstrated 3 types of DMDs after ocular surface burns and revealed that the limbal involvement and retrocorneal exudations may give clues to DMD in the corresponding areas. DMDs may be neglected for long in patients with extensive limbal involvement in early stages and also play an important role in unstable ocular surface condition until the late stages of conjunctivalization after ocular surface burns.
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Affiliation(s)
- Yuan-Ting Li
- Department of Ophthalmology, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China; and
| | - Wen-Yu Wu
- Department of Ophthalmology, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China; and
| | - Jing-Yi Li
- Department of Ophthalmology, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China; and
| | - Szy-Yann Chan
- Department of Ophthalmology, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China; and
| | - Marcus Ang
- Singapore National Eye Center, Singapore Eye Research Institute, Singapore.
| | - Yun Feng
- Department of Ophthalmology, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China; and
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Carletti P, Sepulveda Beltran PA, Levine H, Dubovy SR, Perez VL, Amescua G. Long-Term Comprehensive Management of Bilateral Limbal Stem Cell Deficiency Secondary to Severe Chemical Burn: 10 Years of Follow-Up. Ocul Immunol Inflamm 2023; 31:1629-1634. [PMID: 35816015 DOI: 10.1080/09273948.2022.2090965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 06/13/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE To describe the long-term management of bilateral limbal stem cell deficiency secondary to a severe chemical burn. METHODS Descriptive case report. IMPORTANCE This case highlights the importance of early intervention in ocular chemical burns for the preservation of tissue integrity and avoidance of perforation. We also review the use of proper ocular surface reconstructive techniques to restore the function of the limbal area, as well as the immunomodulatory strategies and follow-up needed for these interventions.
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Affiliation(s)
- Piero Carletti
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | | | - Harry Levine
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Sander R Dubovy
- Florida Lions Ocular Pathology Laboratory, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Victor L Perez
- Duke Eye Center, Duke University, Durham, North Carolina, USA
- Foster Center for Ocular Immunology, Duke University, Durham, North Carolina, USA
| | - Guillermo Amescua
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
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13
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Yao TY, Wang JS, Geng W, Xie HT, Zhang MC. Conjunctival Limbal Autograft Combined with Amnion-Assisted Conjunctival Epithelial Redirection for Unilateral Total Limbal Stem Cell Deficiency after Severe Chemical Burn. J Clin Med 2023; 12:6235. [PMID: 37834878 PMCID: PMC10573734 DOI: 10.3390/jcm12196235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 09/14/2023] [Accepted: 09/25/2023] [Indexed: 10/15/2023] Open
Abstract
(1) Background: To evaluate the efficacy of conjunctival limbal autograft (CLAU) combined with the amnion-assisted conjunctival epithelial redirection (ACER) procedure for patients with unilateral total limbal stem cell deficiency (LSCD) caused by severe chemical burn. (2) Methods: A retrospective interventional case series of unilateral total LSCD after chemical burn who underwent CLAU combined with ACER surgery between September 2021 and July 2023 was collected. Outcome measures included epithelialization of the cornea with donor limbus-derived epithelium, best corrected visual acuity (BCVA), and complications. (3) Results: Nine males and one female were included in this study. The mean age was 40.9 ± 9.63 (range, 26 to 55) years. The average duration between injury and CLAU combined with the ACER procedure was 7.67 ± 3.97 (range, 4 to 18) months. All patients achieved corneal epithelialization and improved BCVA. Postoperative complications occurred in four cases, including delayed corneal epithelial healing in one case, delayed amniotic membrane dissolution and detachment in two cases, and recurrence of symblepharon in one case. No complications were noted in the healthy donor eyes. (4) Conclusions: CLAU combined with ACER is a safe and effective treatment for unilateral total LSCD caused by severe chemical burn. This combined surgery restores visual function for patients with corneal blindness caused by chemical burn, reducing the burden on the families and society.
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Affiliation(s)
| | | | | | - Hua-Tao Xie
- Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (T.-Y.Y.); (J.-S.W.); (W.G.)
| | - Ming-Chang Zhang
- Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (T.-Y.Y.); (J.-S.W.); (W.G.)
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Arora A, Shanbhag SS, Mishra DK, Malepati N, Das S, Priyadarshini SR, Mohanty A, Sahu SK. Sequelae of carbide-related thermo-chemical injury: A retrospective analysis. Indian J Ophthalmol 2023; 71:3192-3197. [PMID: 37602607 PMCID: PMC10565917 DOI: 10.4103/ijo.ijo_57_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 05/30/2023] [Accepted: 06/19/2023] [Indexed: 08/22/2023] Open
Abstract
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's Grade I-III burns, while Group B included 12 eyes with Grade IV-VI 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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Affiliation(s)
- Anchal Arora
- Cornea and Anterior Segment Services, Mithu Tulsi Chanrai Campus, LV Prasad Eye Institute, Bhubaneshwar, India
| | - Swapna S Shanbhag
- Cornea and Anterior Segment Services, Kallam Anji Reddy Campus, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Dilip K Mishra
- Ophthalmic Pathology Laboratory, Kallam Anji Reddy campus, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Nikhila Malepati
- Cornea and Anterior Segment Services, Kallam Anji Reddy Campus, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Sujata Das
- Cornea and Anterior Segment Services, Mithu Tulsi Chanrai Campus, LV Prasad Eye Institute, Bhubaneshwar, India
| | - Smruti R Priyadarshini
- Cornea and Anterior Segment Services, Mithu Tulsi Chanrai Campus, LV Prasad Eye Institute, Bhubaneshwar, India
| | - Amrita Mohanty
- Cornea and Anterior Segment Services, Kallam Anji Reddy Campus, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Srikant K Sahu
- Cornea and Anterior Segment Services, Mithu Tulsi Chanrai Campus, LV Prasad Eye Institute, Bhubaneshwar, India
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Kasikci M, Korkmaz I, Palamar M, Egrilmez S, Yagci A, Barut Selver O. Evaluation of the factors that influence surgical outcome in conjunctival-limbal allograft transplantation. Eye (Lond) 2023; 37:2192-2196. [PMID: 36418907 PMCID: PMC10366148 DOI: 10.1038/s41433-022-02314-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 09/08/2022] [Accepted: 11/10/2022] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To evaluate the surgical results and the variables affecting the outcomes in conjunctival-limbal allograft transplantation (CLAL). METHODS Patients who underwent CLAL for limbal stem cell deficiency (LSCD) between 2007 and 2019 were included in the study. LSCD staging was performed according to the staging system developed by the 'Limbal Stem Cell Working Group'. Stage 1C and higher stage LSCD patients were included in the study. 'Successful surgical outcome' was defined as improvement in LSCD stage at 1 year postoperatively. RESULTS A total of 19 eyes of 19 LSCD patients were included. The mean age of the patients was 40.21 ± 14.65 (6-65) years, and the male/female ratio was 12/7. CLAL was performed in 9 (47.3%) patients with Stage 2B, 9 (47.3%) patients with Stage 3 and 1 (5.4%) with Stage 1C. LSCD aetiology; chemical injury (12), vernal keratoconjunctivitis (2), aniridia (1), corneal degeneration (1), and unknown (3). Surgery was successful in 52.6% of cases. Surgical success was associated with lower LSCD stage (p = 0.04). Lower grades of chemical injury at presentation and a longer time interval between injury and CLAL were associated with higher surgical success (p = 0.001; p = 0.001). The mean postoperative follow-up time was 50.77 ± 29.46 (6-98) months. CONCLUSIONS Despite graft rejection and long-term use of immunosuppressants, CLAL is still one of the most preferred techniques in the treatment of bilateral LSCD. Preoperative LSCD stage and degree of chemical burn are important factors affecting the surgical outcome. Also, CLAL surgery should not be rushed and should be performed when inflammation has subsided.
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Affiliation(s)
- Murat Kasikci
- Department of Ophthalmology, Mugla Training and Research Hospital, Mugla, Turkey
| | - Ilayda Korkmaz
- Department of Ophthalmology, Ege University, Izmir, Turkey
| | - Melis Palamar
- Department of Ophthalmology, Ege University, Izmir, Turkey
| | - Sait Egrilmez
- Department of Ophthalmology, Ege University, Izmir, Turkey
| | - Ayse Yagci
- Department of Ophthalmology, Ege University, Izmir, Turkey
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Korkmaz I, Palamar M, Egrilmez S, Gurdal M, Yagci A, Barut Selver O. Evaluation of Limbal Stem Cell Transplant Success in Ocular Chemical Injury. EXP CLIN TRANSPLANT 2023; 21:684-690. [PMID: 34981716 DOI: 10.6002/ect.2021.0393] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES We evaluated limbal stem cell transplant success in limbal stem cell deficiency due to chemical injury at a tertiary eye care center in Turkey with a novel system for describing limbal stem cell deficiency, as developed by the Limbal Stem Cell Working Group. MATERIALS AND METHODS Medical records of 80 eyes of 80 patients after limbal stem cell transplant for limbal stem cell deficiency secondary to chemical injury were included, with patients grouped according to surgical procedure, ie, limbal autograft, limbal allograft, and cultivated limbal epithelial cell transplant. Surgical success was defined as improvement in postoperative year 1 of limbal stem cell deficiency stage. RESULTS Patients' mean age was 37.9 ± 15.7 years (range, 4-71 years). Male/female ratio was 2.4. Forty-five patients (56.3%) were injured with alkaline substance, and 16 (20%) with acid substance. Mean follow-up time was 60.3 ± 30.6 months (range, 6-118.6 months). Limbal autograft, allograft, and cultivated limbal epithelial cell transplants were performed in 58 (72.5%), 12 (15%), and 10 (12.5%) eyes, respectively. Intervals between injury and surgery in limbal autograft, limbal allograft, and cultivated limbal epithelial cell transplants were 43.3 ± 94.1 months (range, 0.5-592 months), 14.5 ± 10.6 months (range, 2.4-32.5 months), and 122.8 ± 158.9 months (range, 21.1-504 months),respectively (P = .02); and surgical success rates in each group were 65.5%, 41.7%, and 90%, respectively (P = .03). Overall surgical success rate was 65%. CONCLUSIONS Accurate determination of the limbal stem cell deficiency stage is crucial for proper evaluation of surgical success. Surgery type and interval between injury and surgery were the most important factors associated with higher surgical success rates. Despite the limited number of patients in the subgroups, the results were remarkable to emphasize the significance of a novel limbal stem cell deficiency scoring system.
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Affiliation(s)
- Ilayda Korkmaz
- From the Department of Ophthalmology, Ege University, Izmir, Turkey
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Arora A, Sahu SK, Muni I, Sharma A. Use of Ethylenediaminetetraacetic Acid in Chronic Calcium-Based Chemical Injury. Cornea 2023; 42:1034-1036. [PMID: 36729674 DOI: 10.1097/ico.0000000000003203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 10/13/2022] [Indexed: 02/03/2023]
Abstract
PURPOSE This study presents the successful management of a patient with chronic chemical-based injury using ethylenediaminetetraacetic acid (EDTA) chelation. METHODS This is a case report of a 59-year-old man who presented to us 2 months after a bilateral, accidental, ocular injury with lime particles at his workplace. RESULTS The patient was initially managed with extensive debridement and amniotic membrane grafting for both eyes. At 4-month follow-up, the left eye appeared to have extensive calcium-based plaques. 0.02N EDTA chelation was performed for his left eye. Postchelation, the visual acuity improved to 20/800. At 1-week follow-up, a repeat EDTA chelation was performed. The corneal clarity improved further, and the patient recovered a visual acuity of 20/200. CONCLUSIONS EDTA chelation in the setting of calcium deposition in the chronic phase of chemical injuries can be reasonably effective.
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Affiliation(s)
- Anchal Arora
- Cornea and Anterior Segment Services, Mithu Tulsi Chanrai Campus, LV Prasad Eye Institute, Bhubaneshwar, India
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18
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Lata S, Bari A, Agarwal T. Tectonic Deep Anterior Lamellar Keratoplasty in Severe Ocular Chuna Particle Injury in a Child. Cureus 2023; 15:e41712. [PMID: 37575863 PMCID: PMC10415958 DOI: 10.7759/cureus.41712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2023] [Indexed: 08/15/2023] Open
Abstract
A 10-year-old child presented to eye casualty with pain, watering and photophobia of the left eye for one month. Parents gave a history of chuna (lime) falling inside the eye one month back, following which the patient consulted at a primary health centre. However, there was no relief of symptoms and the patient was referred to a higher centre. On examination under anaesthesia, the eye was full of chuna particles. Removal of all visible chuna particles and the corneal chuna plaque was planned. Intra-operatively, the stromal melt was noted around the corneal chuna plaque extending up to Descemet's membrane. Microscope-integrated optical coherence tomography (Mi-OCT) guided removal of corneal chuna particles was done. A tectonic deep anterior lamellar keratoplasty (DALK) along with amniotic membrane graft (AMG) and symblepharon ring placement was done. Two weeks post-operatively, the patient was having a persistent epithelial defect. A repeat AMG with a symblepharon ring was done. On one month follow-up, the epithelial defect had healed. This case emphasises the fact that ocular chemical injuries are an emergency requiring urgent and apt management. In cases of severe ocular chuna injury with delayed presentation, removal of all particles, maintenance of globe integrity and ocular surface restoration is a challenging goal. Healing is slow and visual prognosis is generally guarded in such cases.
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Affiliation(s)
- Suman Lata
- Ophthalmology, All India Institute of Medical Sciences, New Delhi, IND
| | - Aafreen Bari
- Ophthalmology, All India Institute of Medical Sciences, New Delhi, IND
| | - Tushar Agarwal
- Ophthalmology, All India Institute of Medical Sciences, New Delhi, IND
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Kate A, Sharma S, Yathish S, Das AV, Malepati N, Donthineni PR, Basu S, D’Souza S, Shanbhag SS. Demographic profile and clinical characteristics of patients presenting with acute ocular burns. Indian J Ophthalmol 2023; 71:2694-2703. [PMID: 37417107 PMCID: PMC10491055 DOI: 10.4103/ijo.ijo_3330_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 04/23/2023] [Accepted: 05/30/2023] [Indexed: 07/08/2023] Open
Abstract
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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Affiliation(s)
- Anahita Kate
- Shantilal Shanghvi Cornea Institute, L V Prasad Eye Institute, Vijayawada, Andhra Pradesh, India
| | - Supriya Sharma
- Shantilal Shanghvi Cornea Institute, L V Prasad Eye Institute, Hyderabad, Telangana, India
- Cornea and Anterior Segment Services, Shantilal Shanghvi Eye Institute, Mumbai, Maharashtra, India
| | - S Yathish
- Department of Cornea and Refractive Surgery, Narayana Nethralaya, Bangalore, Karnataka, India
| | - Anthony Vipin Das
- Department of Eye Smart EMR and AEye, Indian Health Outcomes, Public Health and Economics Research Center, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Nikhila Malepati
- Shantilal Shanghvi Cornea Institute, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Pragnya R Donthineni
- Shantilal Shanghvi Cornea Institute, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Sayan Basu
- Shantilal Shanghvi Cornea Institute, L V Prasad Eye Institute, Hyderabad, Telangana, India
- Center for Ocular Regeneration (CORE), L V Prasad Eye Institute, Hyderabad, Telangana, India
- Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Sharon D’Souza
- Department of Cornea and Refractive Surgery, Narayana Nethralaya, Bangalore, Karnataka, India
| | - Swapna S Shanbhag
- Shantilal Shanghvi Cornea Institute, L V Prasad Eye Institute, Hyderabad, Telangana, India
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Moshirfar M, Masud M, Harvey DH, Payne C, Bruce E, Ronquillo YC, Hoopes PC. The Multifold Etiologies of Limbal Stem Cell Deficiency: A Comprehensive Review on the Etiologies and Additional Treatment Options for Limbal Stem Cell Deficiency. J Clin Med 2023; 12:4418. [PMID: 37445454 DOI: 10.3390/jcm12134418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 06/16/2023] [Accepted: 06/28/2023] [Indexed: 07/15/2023] Open
Abstract
Given the various ocular manifestations of limbal stem cell insufficiency, an awareness of the genetic, acquired, and immunological causes and associated additional treatments of limbal stem cell deficiency (LSCD) is essential for providers. We performed a comprehensive review of the literature on the various etiologies and specific therapies for LSCD. The resources utilized in this review included Medline (PubMed), Embase, and Google Scholar. All English-language articles and case reports published from November 1986 through to October 2022 were reviewed in this study. There were collectively 99 articles on these topics. No other exclusion criteria were applied. Depending on the etiology, ocular manifestations of limbal stem cell deficiency range from dry eye syndrome and redness to more severe outcomes, including corneal ulceration, ocular surface failure, and vision loss. Identifying the source of damage for LSCD is critical in the treatment process, given that therapy may extend beyond the scope of the standard protocol, including artificial tears, refractive surgery, and allogeneic stem cell transplants. This comprehensive review of the literature demonstrates the various genetic, acquired, and immunological causes of LSCD and the spectrum of supplemental therapies available.
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Affiliation(s)
- Majid Moshirfar
- Hoopes Vision Research Center, Hoopes Vision, Draper, UT 84020, USA
- John A. Moran Eye Center, School of Medicine, University of Utah, Salt Lake City, UT 84132, USA
- Utah Lions Eye Bank, Murray, UT 84107, USA
| | - Maliha Masud
- School of Medicine, University of Nevada Reno, Reno, NV 89557, USA
| | - Devon Hori Harvey
- College of Medicine, The Ohio State University, Columbus, OH 43210, USA
| | - Carter Payne
- Hoopes Vision Research Center, Hoopes Vision, Draper, UT 84020, USA
| | - Elayna Bruce
- McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | | | - Philip C Hoopes
- Hoopes Vision Research Center, Hoopes Vision, Draper, UT 84020, USA
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21
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Yao G, Mo X, Liu S, Wang Q, Xie M, Lou W, Chen S, Pan T, Chen K, Yao D, Lin Y. Snowflake-inspired and blink-driven flexible piezoelectric contact lenses for effective corneal injury repair. Nat Commun 2023; 14:3604. [PMID: 37330515 PMCID: PMC10276863 DOI: 10.1038/s41467-023-39315-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 06/06/2023] [Indexed: 06/19/2023] Open
Abstract
The cornea is a tissue susceptible to various injuries and traumas with a complicated cascade repair process, in which conserving its integrity and clarity is critical to restoring visual function. Enhancing the endogenous electric field is recognized as an effective method of accelerating corneal injury repair. However, current equipment limitations and implementation complexities hinder its widespread adoption. Here, we propose a snowflake-inspired, blink-driven flexible piezoelectric contact lens that can convert mechanical blink motions into a unidirectional pulsed electric field for direct application to moderate corneal injury repair. The device is validated on mouse and rabbit models with different relative corneal alkali burn ratios to modulate the microenvironment, alleviate stromal fibrosis, promote orderly epithelial arrangement and differentiation, and restore corneal clarity. Within an 8-day intervention, the corneal clarity of mice and rabbits improves by more than 50%, and the repair rate of mouse and rabbit corneas increases by over 52%. Mechanistically, the device intervention is advantageous in blocking growth factors' signaling pathways specifically involved in stromal fibrosis whilst preserving and harnessing the signaling pathways required for indispensable epithelial metabolism. This work put forward an efficient and orderly corneal therapeutic technology utilizing artificial endogenous-strengthened signals generated by spontaneous body activities.
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Affiliation(s)
- Guang Yao
- School of Materials and Energy, University of Electronic Science and Technology of China, Chengdu, 610054, Sichuan, China.
- State Key Laboratory of Electronic Thin films and Integrated Devices, University of Electronic Science and Technology of China, Chengdu, 610054, Sichuan, China.
- Shenzhen Institute for Advanced Study, University of Electronic Science and Technology of China, Shenzhen, 518110, China.
| | - Xiaoyi Mo
- School of Materials and Energy, University of Electronic Science and Technology of China, Chengdu, 610054, Sichuan, China
| | - Shanshan Liu
- MOE Key Laboratory for Neuroinformation, The Clinical Hospital of Chengdu Brain Sciences Institute, University of Electronic Science and Technology of China, Chengdu, 610054, Sichuan, China
| | - Qian Wang
- School of Materials and Energy, University of Electronic Science and Technology of China, Chengdu, 610054, Sichuan, China
| | - Maowen Xie
- School of Materials and Energy, University of Electronic Science and Technology of China, Chengdu, 610054, Sichuan, China
| | - Wenhao Lou
- School of Materials and Energy, University of Electronic Science and Technology of China, Chengdu, 610054, Sichuan, China
| | - Shiyan Chen
- Department of Ophthalmology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Medical School, University of Electronic Science and Technology of China, Chengdu, 610054, Sichuan, China
| | - Taisong Pan
- School of Materials and Energy, University of Electronic Science and Technology of China, Chengdu, 610054, Sichuan, China
| | - Ke Chen
- MOE Key Laboratory for Neuroinformation, The Clinical Hospital of Chengdu Brain Sciences Institute, University of Electronic Science and Technology of China, Chengdu, 610054, Sichuan, China.
- Department of Ophthalmology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Medical School, University of Electronic Science and Technology of China, Chengdu, 610054, Sichuan, China.
| | - Dezhong Yao
- MOE Key Laboratory for Neuroinformation, The Clinical Hospital of Chengdu Brain Sciences Institute, University of Electronic Science and Technology of China, Chengdu, 610054, Sichuan, China
| | - Yuan Lin
- School of Materials and Energy, University of Electronic Science and Technology of China, Chengdu, 610054, Sichuan, China.
- State Key Laboratory of Electronic Thin films and Integrated Devices, University of Electronic Science and Technology of China, Chengdu, 610054, Sichuan, China.
- Medico-Engineering Cooperation on Applied Medicine Research Center, University of Electronic Science and Technology of China, Chengdu, 610054, Sichuan, China.
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22
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Arora A, Priyadarshini SR, Das S, Mohanty A, Shanbhag SS, Sahu SK. Carbide Gun-Related Ocular Injuries: A Case Series. Cornea 2023; 42:726-730. [PMID: 35867658 DOI: 10.1097/ico.0000000000003095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 05/23/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to report a case series of sight-threatening ocular injuries caused by calcium carbide guns used as fire crackers. METHODS Medical records of 15 eyes of 14 patients with ocular injuries caused while using carbide guns, visiting the Institute, from January 2021 to January 2022, were retrospectively reviewed. The collected data included patients' demography (age, sex), presenting ophthalmic features, management, and outcome. Grade I and II ocular injuries were managed medically. All grade III-V injuries were managed using Amniotic Membrane Transplantation. RESULTS All patients were male. The mean age of the patients was 23.57 ± 11.76 years. According to the Dua classification, 5 eyes (33.3%) had Grade I-II ocular surface burns, 3 eyes (20%) had grade III burns, and 7 eyes (46.6%) had grade IV-VI burns. Presenting visual acuity ranged between hand movements to 20/50, and in 6 eyes (40%), the visual acuity was ≤20/200. Five eyes were managed medically alone, and 10 (66.6%) eyes needed surgical intervention (Amniotic Membrane Transplantation). After a mean follow-up of 14.23 ± 11.92 weeks, complete epithelization was seen in 10 eyes (66.6%). Partial limbal stem cell deficiency and its sequelae such as conjunctivalization of the cornea were noted in 7 eyes (46.6%). CONCLUSIONS Calcium carbide-related ocular injuries can result in corneal blindness secondary to limbal stem cell deficiency in young individuals. Loss of vision in this age group can lead to loss of economic productivity and cosmetic disfigurement. More advocacy efforts are thus needed to prevent these injuries.
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Affiliation(s)
- Anchal Arora
- Cornea and Anterior Segment Services, Mithu Tulsi Chanrai Campus, LV Prasad Eye Institute, Bhubaneshwar; and
| | - Smruti Rekha Priyadarshini
- Cornea and Anterior Segment Services, Mithu Tulsi Chanrai Campus, LV Prasad Eye Institute, Bhubaneshwar; and
| | - Sujata Das
- Cornea and Anterior Segment Services, Mithu Tulsi Chanrai Campus, LV Prasad Eye Institute, Bhubaneshwar; and
| | - Amrita Mohanty
- Cornea and Anterior Segment Services, Mithu Tulsi Chanrai Campus, LV Prasad Eye Institute, Bhubaneshwar; and
| | - Swapna S Shanbhag
- Cornea and Anterior Segment Services, Kallam Anji Reddy Campus, LV Prasad Eye Institute, Hyderabad.Funded by the Hyderabad Eye Research Foundation
| | - Srikant Kumar Sahu
- Cornea and Anterior Segment Services, Mithu Tulsi Chanrai Campus, LV Prasad Eye Institute, Bhubaneshwar; and
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23
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Balboa Miró M, Monés Llivina A, Romanic Bubalo N, Arango Rodríguez A, Sabala Llopart A, Valldeperas X. Umbilical cord serum for the management of severe bilateral corneal chemical burn in a pediatric patient. J Fr Ophtalmol 2023; 46:e126-e128. [PMID: 36804113 DOI: 10.1016/j.jfo.2022.09.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 08/03/2022] [Accepted: 09/19/2022] [Indexed: 02/17/2023]
Affiliation(s)
- M Balboa Miró
- Ophthalmology Department, Germans Trias y Pujol Hospital, Carretera de Canyet N/N, 08916 Badalona, Barcelona, Spain.
| | - A Monés Llivina
- Ophthalmology Department, Germans Trias y Pujol Hospital, Carretera de Canyet N/N, 08916 Badalona, Barcelona, Spain
| | - N Romanic Bubalo
- Ophthalmology Department, Germans Trias y Pujol Hospital, Carretera de Canyet N/N, 08916 Badalona, Barcelona, Spain
| | - A Arango Rodríguez
- Ophthalmology Department, Germans Trias y Pujol Hospital, Carretera de Canyet N/N, 08916 Badalona, Barcelona, Spain
| | - A Sabala Llopart
- Ophthalmology Department, Germans Trias y Pujol Hospital, Carretera de Canyet N/N, 08916 Badalona, Barcelona, Spain
| | - X Valldeperas
- Ophthalmology Department, Germans Trias y Pujol Hospital, Carretera de Canyet N/N, 08916 Badalona, Barcelona, Spain
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Lu Z, Chu T, Yang ZH, Xia X, Shen YH, Chen JH, Wang JH. Epidemiological features and management of eye burn patients in Wuxi, China. BMJ Open Ophthalmol 2023. [DOI: 10.1136/bmjophth-2022-001171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BackgroundThe current study aimed to analyse epidemiological data on eye burns in Wuxi, China, for the years 2015–2021, and to provide insight into the development of appropriate prevention strategies.MethodsA retrospective study was conducted on 151 hospitalised patients with eye burns. Data collected included gender, age, the monthly distribution of incidence, cause of eye burn, the site of eye burn, the type of surgery, visual outcome, the length of hospital stay and the cost of hospital admission. Statistical analysis was performed using SPSS V.19.0 and Graph Pad Prism V.9.0.ResultsIn a total of 151 eye burn patients, 130 were males (86.09%) and 21 were females (13.91%). The proportion of patients classified as grade III was the greatest (46.36%). The average age of our hospitalised patients with eye burns was 43.72 years and the average length of hospital stay was 17 days. The number of injuries was highest in September (14.6%). Among eye burn patients, workers and farmers became the most common occupations (62.91%, 12.58%). The most frequent cause of burns was alkali burns (19.21%), followed by acid burns (16.56%). When admitted to the hospital, patients’ average vision was 0.06, and 49% of them had a poor vision (<0.3, ≥0.05).ConclusionWith an investigation of 7-year hospitalisation data, the current study provided a fundamental reference for epidemiological features and management of eye burns in Wuxi, China, which could contribute to the development of treatment and prevention strategies.
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Precision of limbal ischemia evaluation in ocular chemical injuries with anterior segment optical coherence tomography angiography. Graefes Arch Clin Exp Ophthalmol 2023; 261:155-159. [PMID: 35857088 DOI: 10.1007/s00417-022-05735-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 05/10/2022] [Accepted: 06/03/2022] [Indexed: 01/04/2023] Open
Abstract
PURPOSE To evaluate the limbal ischemia objectively in ocular surface chemical injuries by using anterior segment optical coherence tomography angiography (AS-OCTA). METHODS In this cross-sectional study, acute ocular surface chemical injury patients with less than 1 week injury history were enrolled. Demographic data of the patients were noted, and detailed ophthalmological examination with Dua classification was performed. AS photographs and AS-OCTA images were obtained and used for the assessment of limbal ischemia. To visualize the limbal vasculature, the device was focused manually to get a sharp image for all 4 quadrants of the limbus. The absence of vasculature was regarded as "ischemia," and the amount of the ischemia was defined in clock hours. The limbal ischemia detected in clinical evaluation with biomicroscopy was compared with the AS-OCTA detected ischemia amount to make a conclusion for the correlation. RESULTS Nineteen eyes of 18 patients with acute ocular surface chemical injury were enrolled to the study (2 female, 16 male). The mean age was 35.1 ± 10 (18-55), and the mean best corrected visual acuity was 0.75 ± 1 (0.1-3.1) LogMAR. The causative agents were acid in 6 and alkaline in 12 patients. Limbal ischemia detected by using AS-OCTA was greater ((5.8 ± 2.6 (2-10) clock hours) than that detected in biomicroscopy (4.8 ± 2.4 (2-12) clock hours). The difference was statistically significant (p < 0.0005). CONCLUSION AS-OCTA has a significant importance on limbal vascularity visualization; therefore, its use for more objective and sensitive evaluation of limbal ischemia in ocular surface chemical injuries seems to have a crucial impact. AS-OCTA images may reveal the extension of limbal ischemia more precisely than clinical evaluation with biomicroscopy. However, future studies with higher number of patients are needed to come to a specific conclusion.
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Kumar A, Chaurasiya D, Sultan S, Soni D, Kubrey S, Singh P, Verma S, Mohan RR, Sharma B. Therapeutic Profile of Human Umbilical Cord Blood Serum and Autologous Serum Therapies in Treatment of Ocular Surface Disorders: A Pilot Study. J Ocul Pharmacol Ther 2023; 39:36-47. [PMID: 36607768 DOI: 10.1089/jop.2022.0107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Purpose: Umbilical cord blood serum (UCBS) is an effective adjunctive treatment along with conventional therapy in ocular surface disorders (OSDs). It aids in rapid ocular surface restoration thereby achieving epithelial integrity, in addition to improvement in subjective and objective parameters. The study aims to compare the efficacy of human umbilical cord blood serum and autologous serum (AS) in treatment of OSD. Methods: A prospective randomized study was conducted on 101 eyes diagnosed with OSD resulting from dry eye disease (DED; n = 40), acute chemical burn (ACB; n = 21), and ocular allergy (OA; n = 40). Randomization was done in Group I, administered with AS, and Group II with UCBS. Outcomes evaluated were visual acuity (VA), eye sensation score (ESS), ocular surface disease index (OSDI), tear break-up time (TBUT), Schirmer's value, Corneal Fluorescein Score, epithelial defect, limbal ischemia, corneal clarity (CC), and improvement in grade of severity. Statistical analysis was done using Wilcoxon signed-rank, Wilcoxon rank sum, Chi-square, and Z-test with a significance level (P ≤ 0.05). Results: In DED, Group II showed significant improvement in VA, ESS, and OSDI by the 7th day, whereas the mean Schirmer, TBUT, and corneal fluorescein staining score improved by 3 months. In ACB, Group II showed improvement in VA, reepithelialization, reduction in limbal ischemia, and CC by 3 months. In OA, Group II showed improvement in ESS by day 7. Conclusion: Human umbilical cord blood serum is more effective than AS in restoring ocular surface.
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Affiliation(s)
- Akhilesh Kumar
- Department of Ophthalmology, Gandhi Medical College, Bhopal, India
| | | | - Shabana Sultan
- Department of Obstetrics and Gynecology, Gandhi Medical College, Bhopal, India
| | - Deepak Soni
- Department of Ophthalmology, All India Institute of Medical Sciences, Bhopal, India
| | - Suraj Kubrey
- Department of Ophthalmology, Gandhi Medical College, Bhopal, India
| | - Priti Singh
- Department of Ophthalmology, All India Institute of Medical Sciences, Bhopal, India
| | - Sunil Verma
- Department of Ophthalmology, All India Institute of Medical Sciences, Bhopal, India
| | - Rajiv R Mohan
- Department of Ophthalmology, College of Veterinary Medicine, Surgery and Mason Eye Institute, University of Missouri, Columbia, Missouri, USA
| | - Bhavana Sharma
- Department of Ophthalmology, Gandhi Medical College, Bhopal, India.,Department of Ophthalmology, All India Institute of Medical Sciences, Bhopal, India
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Salvador-Culla B, Hogg J, Okonkwo A, Mulroy J, Figueiredo GS, Figueiredo FC. Severe chemical eye injuries - clinical outcomes and associated socio-economic factors. Scars Burn Heal 2023; 9:20595131231180367. [PMID: 37781443 PMCID: PMC10536839 DOI: 10.1177/20595131231180367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023] Open
Abstract
Aims To describe clinical outcomes, management, and socio-economic impact of severe acute chemical eye injuries in a tertiary hospital. Methods 37 patients required emergency admission to the Royal Victoria Infirmary eye ward between April 2013 and September 2015. Demographics, best corrected distance visual acuity (BCDVA), causative agent, degree of limbal stem cell deficiency (LSCD), management and socio-economic data were evaluated. Results Mean age on admission was 34.5 years (SD 16.3; range 16-82); 30 males (81.1%); 22 bilateral (59.5%). Causative agent: alkali in 30 cases (81.1%); acid in three cases (8.1%); and unknown in four cases (10.8%). Fifteen cases (40.5%) were assaults, 12 (32.5%) work-related accidents, nine (24.3%) domestic accidents and one (2.7%) undetermined. Eleven patients (29.7%) were unemployed, 18 (48.6%) were labourers, three (8.1%) were students, three (8.1%) were retired and two (5.4%) were professionals. Mean admission time was five days (SD 3.2; range 1-12). Mean follow-up time was 170.5 days (range 1-946). Mean cost of admission was £2478 (range £274-5785). Five patients (13%; seven eyes) developed total or partial limbal stem cell deficiency, all being assaults. Conclusions Main causative agent in our study was alkali, with young men in the working age being most frequently involved. Many patients required prolonged hospital admission and costly follow-up. The majority of cases were assaults, mostly occurring in unemployed patients. All the limbal stem cell deficiency cases were due to assaults. We believe that socio-economic factors play an important role in the cause, severity and cost of chemical eye injuries. Lay Summary Acute chemical eye injuries have a significant and extensive impact on patients' visual function outcomes and vision-related quality of life, with consequent enormous burden to affected individuals, their families and society. We believe that by understanding the socio-economic environment, we may not only be able to enforce safety measures to tackle the increasing rate of severe chemical eye injuries in our community, but also to develop collaborative programmes with the community, educating the population on the seriousness of chemical eye injuries, and with the local authorities, trying to understand the clustering of assaults in areas and tackling the associated socio-economic risk factors, such as unemployment. Given the increasing rate of assaults using chemicals in recent times, it is also important to assess availability of adequate victim support programmes and develop good interaction with relevant local, regional and national authorities to ensure all aspects of community security service are in place to be able to address any potential deficiencies in line with police and home office guidelines. Keeping in mind that the best action plan is always prevention. However, when an ocular injury does occur it is evident that significant morbidity and visual sequelae can result and affect the socio-economic status of the victims despite our best current medical and surgical care.
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Affiliation(s)
| | - Jeffrey Hogg
- Department of Ophthalmology, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Arthur Okonkwo
- Department of Ophthalmology, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Julie Mulroy
- Department of Ophthalmology, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | | | - Francisco C. Figueiredo
- Department of Ophthalmology, Royal Victoria Infirmary, Newcastle upon Tyne, UK
- Bioscience Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
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Kaplan AT, Yalcin SO, Günaydın NT, Kaymak NZ, Gün RD. Ocular-periocular burns in a tertiary hospital: Epidemiologic characteristics. J Plast Reconstr Aesthet Surg 2023; 76:208-215. [PMID: 36527902 DOI: 10.1016/j.bjps.2022.10.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 10/10/2022] [Accepted: 10/25/2022] [Indexed: 11/08/2022]
Abstract
PURPOSE Ocular burns are ophthalmic emergencies that can cause devastating injuries. This study aimed to analyze the epidemiology, complications, and management of ocular-periocular burns. METHODS A total of 193 patients with ocular-periocular burns were admitted to our tertiary hospital from January 2018 to December 2020. The demographic characteristics of the patients, injury variables, complications, and treatments were evaluated. RESULTS There were 142 male (73.6%) and 51 female (26.4%) patients with a mean age of 32.53±17.75 years. The average total body surface area was 12% (range, 1-80%). Injuries were most common at work (52.3%) and home (36.3%). Thermal burns were the most common injuries (74.6%), followed by chemical (14.5%) and electrical burns (10.9%). Alkaline agents (75.0%), mainly sodium hydroxide and lime, were common in chemical burns. Superficial lid burns were significantly higher in the thermal group (p < 0.001), and grade III-IV corneal burns were significantly higher in the chemical group (p < 0.001). Various complications were developed in 50 (13%) eyes. Medical treatment only was performed in 318 (82.4%) eyes, and additional surgical treatment was performed in 64 (17.6%) eyes; however, 54 (14.0%) underwent more than one surgery. The most common complications were corneal scars (7.3%), limbal deficiency (4.1%), and ectropion (3.9%). The most frequent procedures performed were amniotic membrane transplantation (AMT) (11.9%) and tarsorrhaphy (6.7%). CONCLUSION Chemical burns, limbal and conjunctival ischemia, and full-thickness eyelid defects had a poor prognosis. The degree of limbal deficiency and ınjury of intraocular structures were found to have a great influence on the outcome of their visual acuity.
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Affiliation(s)
- Aysin Tuba Kaplan
- Ophthalmology Department, SBU Kartal Dr. Lutfi Kırdar City Hospital, Kartal, Istanbul 34865, Turkey.
| | - Sibel Oskan Yalcin
- Ophthalmology Department, SBU Kartal Dr. Lutfi Kırdar City Hospital, Kartal, Istanbul 34865, Turkey
| | - Nesrin Tutas Günaydın
- Ophthalmology Department, SBU Kartal Dr. Lutfi Kırdar City Hospital, Kartal, Istanbul 34865, Turkey
| | - Nilüfer Zorlutuna Kaymak
- Ophthalmology Department, SBU Kartal Dr. Lutfi Kırdar City Hospital, Kartal, Istanbul 34865, Turkey
| | - Raziye Dönmez Gün
- Ophthalmology Department, SBU Kartal Dr. Lutfi Kırdar City Hospital, Kartal, Istanbul 34865, Turkey
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Tian B, Zeng L, Lin L, Lao HY, Xu Y, Zhang Y, Ou Z, Zhou J, Yi Y, Chen M, Gu J. Pediatric Chemical and Thermal Ocular Injuries Requiring Hospitalization in South China. Semin Ophthalmol 2022:1-7. [DOI: 10.1080/08820538.2022.2140012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Bishan Tian
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, 510060, China
| | - Liangbo Zeng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, 510060, China
| | - Lixia Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, 510060, China
| | - Hubert Yuenhei Lao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, 510060, China
| | - Yuwei Xu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, 510060, China
| | - Yuying Zhang
- Department of Ophthalmology, Guangdong Women and Children Hospital, Guangzhou, China
| | - Zhancong Ou
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, 510060, China
| | - Jin Zhou
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, 510060, China
| | - Yuhuan Yi
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, 510060, China
| | - Miao Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, 510060, China
| | - Jianjun Gu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, 510060, China
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Luisi J, Lin JL, Karediya N, Kraft ER, Sharifi A, Schmitz-Brown ME, Zhang W, Ameredes BT, Merkley KH, Motamedi M, Gupta PK. Concentration-associated pathology of alkali burn in a mouse model using anterior segment optical coherence tomography with angiography. Exp Eye Res 2022; 223:109210. [PMID: 35987418 DOI: 10.1016/j.exer.2022.109210] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 07/29/2022] [Accepted: 08/02/2022] [Indexed: 11/26/2022]
Abstract
Pathological features of alkali concentration-associated burn were studied using non-invasive anterior segment optical coherence tomography (AS-OCT) and OCT angiography (OCTA). Alkali burn was induced in C57BL/6J mice (n = 20) by placing filter paper soaked in 0.1, 0.25, 0.5, and 1 M NaOH for 30s on the right eye (left eye control). Longitudinal imaging was performed with AS-OCT/OCTA and fluorescein angiography over 14 days, after which eyes were enucleated at 7 and 14 days for histology and immunofluorescence. Concentration-associated corneal swelling was maximal at 0.5M, increasing linearly in a concentration-dependent fashion at 0.1, 0.25, and 0.5 M NaOH, to levels of 50%, 100%, and 175% of control, respectively. At 0.1M, corneal swelling and surface erosions were prominent, while at 0.25M, deep tissue damage, limbal neovascularization, and stromal haze were evident at 7 days. At 0.5M and 1M, severe exacerbation of the corneal swelling, angle closure, Descemet's membrane detachment, hyphema, and profuse central neovascularization were noted as early as day 3, which further progressed to inflammation, fibrosis, and opacity by day 7. We conclude that alkali concentration-dependent burn intensity biomarkers can be assessed by non-invasive AS-OCT/OCTA, distinguishing between mild, moderate, and severe ocular injury, with potential relevance toward clinical utilization in human eyes.
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Affiliation(s)
- Jonathan Luisi
- Departments of Internal Medicine and Pharmacology and Toxicology, United States; Department of Ophthalmology and Visual Sciences, United States
| | - Jonathan L Lin
- Departments of Internal Medicine and Pharmacology and Toxicology, United States
| | - Nishad Karediya
- Department of Ophthalmology and Visual Sciences, United States
| | - Edward R Kraft
- Department of Ophthalmology and Visual Sciences, United States
| | - Ardalan Sharifi
- Department of Ophthalmology and Visual Sciences, United States
| | | | - Wenbo Zhang
- Department of Ophthalmology and Visual Sciences, United States
| | - Bill T Ameredes
- Departments of Internal Medicine and Pharmacology and Toxicology, United States
| | - Kevin H Merkley
- Department of Ophthalmology and Visual Sciences, United States
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Sharma S, Kate A, Donthineni PR, Basu S, Shanbhag SS. The role of Tenonplasty in the management of limbal and scleral ischemia due to acute ocular chemical burns. Indian J Ophthalmol 2022; 70:3203-3212. [PMID: 36018089 PMCID: PMC9675520 DOI: 10.4103/ijo.ijo_3148_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Of the various manifestations of ocular chemical burns (OCBs), ischemia of the limbus and the peri-limbal sclera indicates poor prognosis and in severe cases threaten the integrity of the globe. Tenonplasty is a surgical procedure which involves advancing the Tenon’s capsule over the ischemic areas to provide a vascular supply and to enable migration of the conjunctival epithelium. This review aims to provide an overview of the diagnosis of limbal ischemia and its management with Tenonplasty. A literature review was conducted using the keywords “Tenonplasty,” “Tenon’s capsule,” “ocular chemical injury,” “ocular thermal injury,” “Tenon advancement,” “scleral ischemia,” and “limbal ischemia,” and outcomes were studied from seven selected articles. In addition to clinical evaluation, in vivo imaging techniques such as anterior segment optical coherence tomography angiography can provide an objective method of measuring and monitoring the ischemia and re-perfusion of the peri-limbal vasculature. Tenonplasty can be performed in eyes with acute OCBs with scleral or limbal ischemia by dissecting the Tenon’s layer from the orbit and securing it to the limbus. The indications, mechanism of action, peri-operative considerations, surgical technique, and post-operative care of Tenonplasty are discussed in detail. The average time for post-operative re-epithelization ranges from 1 to 6 months with the formation of a symblepharon being the most common complication. In conclusion, Tenonplasty is a globe-salvaging procedure in cases with severe limbal and scleral ischemia because of OCBs and has good anatomical outcomes priming the globe for subsequent re-constructive and vision-restoring surgeries.
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Affiliation(s)
- Supriya Sharma
- The Cornea Institute, KAR Campus, Hyderabad, Telangana, India
| | - Anahita Kate
- The Cornea Institute, KVC Campus, LV Prasad Eye Institute, Vijayawada, Andhra Pradesh, India
| | | | - Sayan Basu
- The Cornea Institute, KAR Campus; Center for Ocular Regeneration (CORE); Brien Holden Eye Research Centre, LV Prasad Eye Institute, Hyderabad, Telangana, India
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Clare G, Bunce C, Tuft S. Amniotic membrane transplantation for acute ocular burns. Cochrane Database Syst Rev 2022; 9:CD009379. [PMID: 36047788 PMCID: PMC9435439 DOI: 10.1002/14651858.cd009379.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Ocular surface burns can be caused by chemicals (alkalis and acids) or direct heat. One effect of the burn is damage to the limbal epithelial stem cells of the ocular surface with delayed re-epithelialisation, stem cell failure, and conjunctivalisation of the cornea. Amniotic membrane transplantation (AMT) performed in the acute phase (day 0 to day 7) following an ocular surface burn is claimed to reduce pain and accelerate healing. The surgery involves securing a layer of amniotic membrane (AM) to the eyelid margins as a patch to cover the entire ocular surface. However, there is debate about the severity of an ocular burn that may benefit from AMT and uncertainty of whether AMT improves outcomes. OBJECTIVES To compare the effect of AMT with medical therapy in the first seven days after an ocular surface burn, compared to medical therapy alone. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL; which contains the Cochrane Eyes and Vision Trials Register; 2021, Issue 9); Ovid MEDLINE; Ovid Embase; LILACS; the ISRCTN registry; ClinicalTrials.gov and the WHO ICTRP. We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 29 September 2021. SELECTION CRITERIA We included randomised trials that compared an AMT applied in the first seven days following an ocular surface burn in addition to medical therapy with medical therapy alone. The outcome measures were failure of re-epithelialisation by day 21 post injury, visual acuity at final follow-up, corneal neovascularisation, symblepharon, time to re-epithelialisation and adverse effects. DATA COLLECTION AND ANALYSIS Two review authors independently screened search results, assessed the included studies for risk of bias and extracted relevant data. We contacted trial investigators for missing information. We summarised data using risk ratios (RRs) and mean differences (MDs) as appropriate. MAIN RESULTS We analysed two RCTs, but excluded individual patients who had been treated outside the acute phase in one of the studies (data provided by study authors). In total, 36 moderate burns from one RCT and 92 severe burns from two RCTs were evaluated separately. For both categories, the certainty of the evidence was downgraded principally as a result of high risks of performance and detection biases, and because of imprecision indicated by very wide confidence intervals. In addition, follow-up was insufficiently frequent to calculate time-to-epithelialisation precisely. Moderate severity ocular burns (Roper-Hall classification II-III) The relative risk of AMT on failure of epithelialisation by day 21 was 0.18 (0.02 to 1.31), and LogMAR visual acuity was 0.32 lower (0.55 to 0.09 lower) in the treatment group (i.e. better), suggesting a possible benefit of AMT. The GRADE assessment for failure of epithelialisation by day 21 was downgraded to very low due to the risk of bias and imprecision (very wide confidence intervals including no effect). The GRADE assessment for visual acuity at final follow-up was downgraded to low due to the risk of bias and imprecision (optimal information size not met). The relative effects of AMT on corneal neovascularisation (RR 0.56; 0.21 to 1.48), symblepharon (RR 0.41; 0.02 to 9.48) and time-to-epithelialisation (13 days lower; 26.30 lower to 0.30 higher) suggest possible benefit of AMT, but the wide confidence intervals indicate that both harm and benefit are possible. GRADE assessments for these outcomes were once again downgraded to very low due to the risk of bias and imprecision. Since adverse effects are rare, the small sample would have fewer occurrences of rare but potentially important adverse effects. The GRADE assessment for adverse effects was therefore considered to be low. Severe ocular burns (Roper-Hall classification IV) The relative risk of AMT on failure of epithelialisation by day 21 was 1.03 (0.94 to 1.12), and LogMAR visual acuity was 0.01 higher (0.29 lower to 0.31 higher) in the treatment group (i.e, worse), indicating no benefit of AMT. GRADE assessments for failure of epithelialisation by day 21 and final outcomes were downgraded to low. The relative effects of AMT on corneal neovascularisation (RR 0.84; 0.66 to 1.06), symblepharon (RR 0.89; 0.56 to 1.42) and time-to-epithelialisation (1.66 days lower; 11.09 lower to 7.77 higher) may include both benefit and harm. GRADE assessments for corneal neovascularisation, symblepharon and time-to-epithelialisation were downgraded to low due to risk of bias and imprecision. For adverse effects, the GRADE assessment was downgraded to low, reflecting the small sample sizes in the RCTs. AUTHORS' CONCLUSIONS There is uncertain evidence to support the treatment of moderate acute ocular surface burns with AMT in addition to standard medical therapy as a means of preventing failure of epithelialisation by day 21, improving visual outcome and reducing corneal neovascularisation, symblepharon formation and time-to-epithelialisation. For severe burns, the available evidence does not indicate any significant benefit of treatment with AMT.
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Affiliation(s)
- Gerry Clare
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | | | - Stephen Tuft
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
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Lo SK, Uhl L, Lee J, Cavanagh A, Henriksen MDL. Acidic chemical corneal ulceration secondary to nail polish spill in a puppy. J Vet Emerg Crit Care (San Antonio) 2022; 32:507-511. [PMID: 35001484 DOI: 10.1111/vec.13181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 07/10/2020] [Accepted: 08/16/2020] [Indexed: 12/01/2022]
Abstract
PURPOSE To describe the treatment of an acidic chemical corneal ulceration in a puppy secondary to nail polish spilling on and adhering to the cornea. CASE SUMMARY A 12-week-old neutered male Australian Shepherd mix dog was presented to Colorado State University Veterinary Teaching Hospital's (CSU-VTH) Emergency and Urgent Care service acutely after exposure to nail polish spilling on the left eye (OS). Initial ophthalmic examination revealed nail polish adhered to approximately 80% of the cornea with moderate diffuse corneal edema and chemosis, and green nail polish adhered to the skin and fur of the periocular area. Copious flushing with eye wash was performed, but no areas of reduced nail polish adherence were noted. The patient was treated with 1 drop of topical ofloxacin 0.3% ophthalmic solution OS and hospitalized overnight, receiving hyaluronic acid ophthalmic lubrication every hour OS. The treatment plan was carried out for 6 h until time of transfer. In the morning, CSU-VTH's Ophthalmology service removed a nonadhered nail polish plaque in 1 piece using Bishop-Harmon tissue forceps. Following removal, a superficial ulcer secondary to an acidic chemical burn covering 100% of the corneal surface was noted, as well as moderate diffuse corneal edema. Following topical treatment for 8 days, the superficial ulcer healed completely, with no significant long-term consequences. UNIQUE INFORMATION PROVIDED This is the first report of management of an acidic chemical corneal ulceration secondary to nail polish spill in a puppy. Early assessment and vigilance in treatment was essential for a good prognosis and outcome.
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Affiliation(s)
- Stephanie K Lo
- Ophthalmology Service, Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado, USA
| | - Lisa Uhl
- Ophthalmology Service, Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado, USA
| | - Jack Lee
- Emergency and Critical Care Service, Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado, USA
| | - Amanda Cavanagh
- Emergency and Critical Care Service, Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado, USA
| | - Michala de Linde Henriksen
- Ophthalmology Service, Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado, USA
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Akgun Z, Palamar M, Egrilmez S, Yagci A, Selver OB. Clinical Characteristics and Severity Distribution of Tertiary Eye Center Attendance by Ocular Chemical Injury Patients. Eye Contact Lens 2022; 48:295-299. [PMID: 35580512 DOI: 10.1097/icl.0000000000000908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To report demographic characteristics, types and grades of injury, regional distribution of injury severity, clinical findings, and long-term results of acute ocular chemical burns. METHODS Medical records of patients with chemical burns between 2010 and 2020 who were admitted to Ege University less than 72 hr after the injury were reviewed. Age, gender, cause of the burn, injury severity, initial and final best-corrected visual acuity, surgical intervention, and complications were recorded. The injury severity was graded according to Dua classification. RESULTS A total of 104 patients (137 eyes) were included. The mean age was 42.69±17.39 (7-90) years with a male-to-female ratio of 86:18. The most common causes were home (32.6%) and industrial accidents (45.1%). The causative agent percentages for alkaline, acid, and neutral were 49.0%, 35.5%, and 5.7%, respectively. The percentages of eyes in each grade (1-6) were 16.0%, 16.0%, 15.3%, 16.7%, 17.5%, and 18.2%, respectively. Complications mostly occurred in eyes with grade 2 or higher injuries (83.7%). The relationship between injury grade and limbal stem-cell deficiency was statistically significant (P<0.001). Surgery was mostly needed in grade 4 or higher injuries (44 eyes). CONCLUSION The severity of the burn is one of the most important prognostic factors in chemical burns. It is important to determine the spreading of the regional injury severity beside the global one to predict complication risk of the injuries. In the present study, the injury distribution was homogeneous in all grades. Limbal stem-cell deficiency development took place mostly in grade 5 and 6 burns as expected.
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Affiliation(s)
- Zeynep Akgun
- Department of Ophthalmology, Ege University Hospital, Izmir, Turkey
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Care of the Critically Injured Burn Patient. Ann Am Thorac Soc 2022; 19:880-889. [PMID: 35507538 DOI: 10.1513/annalsats.202110-1099cme] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Care of the critically injured burn patient presents unique challenges to the intensivist. Certified burn centers are rare and geographically sparse, necessitating that much of the initial management of patients with severe burn injuries must happen in the pre-burn center setting.1 Severe burn injuries often lead to a wide range of complications that extend beyond the loss of skin integrity and require specialized care. As such, medical intensivists are often called upon to stabilize these critically injured patients. This focused review outlines the clinical care of these medically complex patients, including airway management, post-burn complications, volume resuscitation, nutrition, and end-of-life care.
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Wang P, Hao P, Chen X, Li L, Zhou Y, Zhang X, Zhu L, Ying M, Han R, Wang L, Li X. Targeting HMGB1-NFκb Axis and miR-21 by Glycyrrhizin: Role in Amelioration of Corneal Injury in a Mouse Model of Alkali Burn. Front Pharmacol 2022; 13:841267. [PMID: 35586052 PMCID: PMC9108160 DOI: 10.3389/fphar.2022.841267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 04/01/2022] [Indexed: 11/13/2022] Open
Abstract
Corneal neovascularization (CNV) is a sight-threatening condition usually associated with various inflammatory settings including chemical injury. High mobility group box 1 (HMGB1) is identified as an inflammatory alarmin in diverse tissue damage. Here, we evaluate the expression of HMGB1 and the consequences of its inhibition through its selective inhibitor glycyrrhizin (GLY) in alkali burn-induced corneal inflammation and neovascularization. GLY effectively attenuated alkali burn-induced HMGB1 expression at both mRNA and protein levels. Furthermore, slit-lamp analysis, ink perfusion, H&E staining, and CD31 histochemical staining showed that GLY relieved corneal neovascularization, while GLY attenuated VEGF expression via inhibiting HMGB1/NF-κB/HIF-1α signal pathway. In addition, GLY treatment decreased the cytokine expression of CCL2 and CXCL5, accompanied by the reduction of their receptors of CCR2 and CXCR2. GLY diminished the inflammatory cell infiltration of the cornea, as well as reduced the expression of IL-1β, IL-6, and TNF-α. Moreover, treatment with GLY reduced the degree of cornea opacity through inactivating extracellular HMGB1 function, which otherwise induces TGF-β1 release and myofibroblast differentiation. Furthermore, we found that GLY treatment attenuated the upregulation of miR-21 levels in alkali burned cornea; while inhibition of miR-21in keratocytes in vitro, significantly inhibited TGF-β1-induced myofibroblast differentiation. Collectively, our results suggested that targeting HMGB1-NFκb axis and miR-21 by GLY could introduce a therapeutic approach to counter CNV.
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Affiliation(s)
- Peihong Wang
- Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China
- Tianjin Eye Hospital, Tianjin Key Laboratory of Ophthalmology and Visual Science, Tianjin Eye Institute, Tianjin, China
| | - Peng Hao
- Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China
- Tianjin Eye Hospital, Tianjin Key Laboratory of Ophthalmology and Visual Science, Tianjin Eye Institute, Tianjin, China
- Nankai University Affiliated Eye Hospital, Tianjin, China
| | - Xi Chen
- Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China
- Tianjin Eye Hospital, Tianjin Key Laboratory of Ophthalmology and Visual Science, Tianjin Eye Institute, Tianjin, China
- Nankai University Affiliated Eye Hospital, Tianjin, China
| | - Linghan Li
- Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China
- Tianjin Eye Hospital, Tianjin Key Laboratory of Ophthalmology and Visual Science, Tianjin Eye Institute, Tianjin, China
| | - Yongying Zhou
- Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China
- Tianjin Eye Hospital, Tianjin Key Laboratory of Ophthalmology and Visual Science, Tianjin Eye Institute, Tianjin, China
| | - Xiaohan Zhang
- Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China
- Tianjin Eye Hospital, Tianjin Key Laboratory of Ophthalmology and Visual Science, Tianjin Eye Institute, Tianjin, China
| | - Lin Zhu
- Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China
- Tianjin Eye Hospital, Tianjin Key Laboratory of Ophthalmology and Visual Science, Tianjin Eye Institute, Tianjin, China
| | - Ming Ying
- Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China
- Tianjin Eye Hospital, Tianjin Key Laboratory of Ophthalmology and Visual Science, Tianjin Eye Institute, Tianjin, China
- Nankai University Affiliated Eye Hospital, Tianjin, China
| | - Ruifang Han
- Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China
- Tianjin Eye Hospital, Tianjin Key Laboratory of Ophthalmology and Visual Science, Tianjin Eye Institute, Tianjin, China
- Nankai University Affiliated Eye Hospital, Tianjin, China
| | - Liming Wang
- Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China
- Tianjin Eye Hospital, Tianjin Key Laboratory of Ophthalmology and Visual Science, Tianjin Eye Institute, Tianjin, China
- Nankai University Affiliated Eye Hospital, Tianjin, China
| | - Xuan Li
- Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China
- Tianjin Eye Hospital, Tianjin Key Laboratory of Ophthalmology and Visual Science, Tianjin Eye Institute, Tianjin, China
- Nankai University Affiliated Eye Hospital, Tianjin, China
- *Correspondence: Xuan Li,
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Tarff A, E.Drew-Bear L, Di Meglio L, Yee R, Adelita Vizcaino M, Gupta P, Annadanam A, Cano M, Behrens A. Effect of topical bovine colostrum in wound healing of corneal surface after acute ocular alkali burn in mice. Exp Eye Res 2022; 220:109093. [DOI: 10.1016/j.exer.2022.109093] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 03/30/2022] [Accepted: 04/22/2022] [Indexed: 12/18/2022]
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Abstract
Chemical burns represent a small number of burn injuries in the UK. They have the potential to be life-threatening with serious aesthetic and functional consequences, accounting for 30% of all deaths from burns. Chemical burns are caused by corrosive agents (acids and alkali) leading to extensive tissue damage. Understanding the pathophysiology of a chemical burn injury and identifying the nature of the offending agent is important for effective management. Prompt assessment and management of chemical injuries is vital to reduce the deleterious effect of the compound involved. This article reviews the pathophysiology of a chemical injury and the management of these burns.
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Affiliation(s)
- Karl Walsh
- The Manchester Centre for Plastic Surgery and Burns, Manchester University Foundation Trust, Manchester, UK
| | - Isabel Hughes
- The Manchester Centre for Plastic Surgery and Burns, Manchester University Foundation Trust, Manchester, UK
| | - Baljit Dheansa
- Department of Burns and Plastics, Queen Victoria Hospital, East Grinstead, UK
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Wang B, Liu ST, Johnson MA, Trigger S. Trends and characteristics of ocular exposures related to e-cigarettes and e-liquids reported to Poison Control Centers in the United States, 2010-2019. Clin Toxicol (Phila) 2022; 60:279-285. [PMID: 34328369 PMCID: PMC10510398 DOI: 10.1080/15563650.2021.1951284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 06/28/2021] [Accepted: 06/29/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Ocular injuries and unintended exposures involving electronic nicotine delivery systems (ENDS), also known as e-cigarettes, have been reported. However, trends and characteristics of ENDS-related ocular exposures at the population level are not well documented. This study was designed to describe trends and characteristics of ENDS-related ocular exposure cases reported to poison control centers (PCCs) in the U.S. METHODS We computed descriptive statistics of ENDS-related ocular exposure cases reported to PCCs between January 1, 2010 and December 31, 2019, including number of cases per year and the distribution of characteristics of those cases. We also summarized case narrative review findings. RESULTS A total of 1,393 ENDS-related ocular exposure cases were reported to PCCs during the study period. Overall number of cases increased from two in 2010 to a peak of 389 in 2014, followed by a steady decline in 2015-2018. Of the 1,393 cases, 42.5% occurred among individuals aged 25 years and older; 20.4 and 17.7% occurred among young adults aged 18-24 years and children younger than five years, respectively. Nearly one quarter (23.8%) of the individuals experiencing ocular exposure sought or were recommended to seek medical attention. Case narrative review found that 59 of 127 (46.5%) cases were due, at least in part, to incorrect use or handling of the products. DISCUSSION AND CONCLUSIONS Our study shows that more than 1,000 ENDS-related ocular exposure cases were reported to PCCs during the study period. Many of these cases involved young children; nearly half were due, at least in part, to incorrect use or handling of the products. Future efforts to prevent these exposures may focus on improving the awareness of the potential harmful effects of ENDS products and the importance of appropriate handling of ENDS products. Health care professionals may play an important role in educating patients and improving surveillance of ENDS-related ocular exposure cases.
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Affiliation(s)
- Baoguang Wang
- Center for Tobacco Products, Office of Science, United States Food and Drug Administration, Silver Spring, MD, USA
| | - Sherry T Liu
- Center for Tobacco Products, Office of Science, United States Food and Drug Administration, Silver Spring, MD, USA
| | - Moronke A Johnson
- Center for Tobacco Products, Office of Science, United States Food and Drug Administration, Silver Spring, MD, USA
| | - Sarah Trigger
- Center for Tobacco Products, Office of Science, United States Food and Drug Administration, Silver Spring, MD, USA
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Use of Autologous Serum Eye Drops with Contact Lenses in the Treatment of Chemical Burn-Induced Bilateral Corneal Persistent Epithelial Defects. BIOMED RESEARCH INTERNATIONAL 2022; 2022:6600788. [PMID: 35237689 PMCID: PMC8885208 DOI: 10.1155/2022/6600788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 02/10/2022] [Indexed: 11/30/2022]
Abstract
Objective We aim to evaluate the clinical effect of combined topical 20% autologous serum eye drops (ASEs) along with silicone–hydrogel soft contact lenses (SCLs) in the treatment of chemical burn-induced bilateral corneal persistent epithelial defects (PEDs) and to review the literature of related studies. Methods From January 1, 2017, to December 31, 2019, we conducted a retrospective chart review of 8 patients with chemical burn-induced bilateral corneal PEDs who were unsuccessfully treated with conventional medical therapy and were then treated with combined topical 20% (v/v) ASEs and silicone–hydrogel CLs. The clinical effects and effectiveness of the combined treatment were evaluated. Results The bilateral corneal PEDs healed in all sixteen eyes of the eight patients within 2 weeks. The patients did not report any discomfort associated with the combined treatment. Improved ocular comfort/visual acuity and decreased conjunctival injection correlated with healing. No recurrent corneal epithelial breakdown was noted during the 3-month posttreatment follow-up. Conclusions The combined treatment of silicone–hydrogel CLs and ASEs can help to stabilize the ocular surface and successfully treat chemical burn-induced bilateral corneal PEDs. It may be considered as an alternative treatment method for patients with bilateral chemical burn-induced corneal PEDs with potential corneal melting.
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Mallone F, Marenco M, Giustolisi R, Plateroti R, Lambiase A. Platelet-Rich Plasma (PRP) to promote corneal healing in firework-related ocular burn and total limbal stem cell deficiency (LSCD). Eur J Ophthalmol 2022; 33:NP18-NP22. [PMID: 35139684 DOI: 10.1177/11206721221080004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To report the case of persistent corneal epithelial defect in total limbal stem cell deficiency (LSCD) after severe firework-related ocular burn treated with autologous Platelet-Rich Plasma (PRP). CASE DESCRIPTION A young patient, victim of fireworks trauma, presented with a large persistent epithelial defect affecting the central cornea of his left eye and progressing to stromal melting, in the context of grade VI ocular surface burn with 12 h limbal involvement. Impression cytology to the cornea confirmed a complete LSCD. Assessment of corneal sensitivity by Cochet Bonnet esthesiometer revealed complete corneal anesthesia. Based on progressive clinical worsening under conventional therapy, the patient was started on very pure autologous PRP eye drops obtained using the Hy-Tissue PRP® technology. Six times a day eye drops administration for 30 days was scheduled in the affected eye. At the end of treatment, the epithelial defect had disappeared being replaced by advancing conjunctiva. CONCLUSION Our findings provide information on management of ocular burns from fireworks, a subject of current interest and concern. Autologous PRP eye drops prepared using the Hy-Tissue PRP® system and administered in the presence of total LSCD and complete corneal anesthesia, prevented corneal stromal melting to progress and allowed the ocular surface epithelial coverage to re-establish. This paved the way for later successful restorative and reconstructive intervention. Also, first description of the Hy-tissue PRP procedure for ophthalmological use is reported.
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Affiliation(s)
- Fabiana Mallone
- Department of Sense Organs, 9311Sapienza University of Rome, Rome, Italy
| | - Marco Marenco
- Department of Sense Organs, 9311Sapienza University of Rome, Rome, Italy
| | - Rosalia Giustolisi
- Department of Sense Organs, 9311Sapienza University of Rome, Rome, Italy
| | - Rocco Plateroti
- Department of Sense Organs, 9311Sapienza University of Rome, Rome, Italy
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Akbas E, Korkmaz I, Palamar M, Barut Selver O. Shifting trends in demographic features of chemical eye injuries during COVID-19 pandemic. Int Ophthalmol 2022; 42:2127-2132. [PMID: 35013832 PMCID: PMC8745549 DOI: 10.1007/s10792-022-02211-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 01/01/2022] [Indexed: 11/25/2022]
Abstract
Objectives To evaluate the etiological cause distribution in chemical eye injuries during COVID-19 pandemic. Methods In this retrospective case series, the medical records of patients, who presented with chemical eye injuries between March 30, 2020, and March 1, 2021, were evaluated and compared with the data covering 10 years before the pandemic. Results Twenty-seven eyes of twenty-three patients (19 adults, 4 children) who presented in pandemic period were included. Alcohol-based hand sanitizer was one of the two most common agents (n = 6 eyes) in the pandemic era. In the last 10 years before the pandemic, 137 eyes of 102 patients were treated for chemical eye injuries. Injuries due to alcohol-based hand sanitizer increased from 3.1 to 21.1% among all patients, and from 0 to 75% among pediatric patients during the pandemic era compared to the pre-pandemic period. The increase was statistically significant both in all patients (p = .003) and in the pediatric patient group (p = .048). Conclusion Due to COVID-19 pandemic, alcohol-based hand sanitizer use became more common. Consequently, the frequency of hand sanitizer related chemical injuries showed a 13-fold increase and the age group affected by such accidents is altered during the pandemic. Three out of four pediatric patients (75%) were injured with alcohol-based hand sanitizers, which draws attention to the fact that improperly placed hand sanitizer stations, being just at the eye level of children, can cause chemical eye injuries in the pediatric population even more.
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Affiliation(s)
- Elif Akbas
- Faculty of Medicine, Department of Ophthalmology, Ege University, 35040, Izmir Bornova, Turkey
| | - Ilayda Korkmaz
- Faculty of Medicine, Department of Ophthalmology, Ege University, 35040, Izmir Bornova, Turkey
| | - Melis Palamar
- Faculty of Medicine, Department of Ophthalmology, Ege University, 35040, Izmir Bornova, Turkey
| | - Ozlem Barut Selver
- Faculty of Medicine, Department of Ophthalmology, Ege University, 35040, Izmir Bornova, Turkey.
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Keilani C, De Faria A, Baus A, Delbarre M, Schaal J, Froussart-Maille F, Bey E, Duhamel P. Eyelid Chemical Burns: A Multidisciplinary And Challenging Approach. ANNALS OF BURNS AND FIRE DISASTERS 2021; 34:312-318. [PMID: 35035323 PMCID: PMC8717906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 08/14/2021] [Indexed: 06/14/2023]
Abstract
During second- and third-degree eyelid sulfuric acid burns, many surgeons prefer to wait until primary wound separation occurs before grafting. However, this approach may miss the chance to recover the eyelids and can cause ectropion, resulting in delayed eyeball healing with exposure keratitis. We propose that early eyelid release and grafting makes a significant difference in long-term outcomes and improves eyeball healing. Here, we present the case of a woman who presented second- and third-degree burns of the eyelids secondary to physical domestic assault with acid, who had an early surgical management with a full-thickness skin graft. Ten days after surgery, we found that the graft had survived totally, and the donor site of the right arm had already healed. Eyelids were successfully grafted and the functions of both eyelids were well recovered, allowing complete cover of the eyeball. Two months after surgery, functional and cosmetic results were satisfying, with no postoperative lagophthalmos or difficulties with exposure-related problems. Case reports of eyelid chemical burns are very few. No specific and codified management of eyelid chemical burns was found in the literature search. This case report demonstrated that a multidisciplinary approach led by both ophthalmologists and plastic surgeons must be decided early (<6h) in order to achieve synergistic and coordinated management between the eye and the eyelid. There is a significant improvement in ocular healing with early excision and grafting of eyelids after sulfuric acid burn.
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Affiliation(s)
- C. Keilani
- Department of Plastic Surgery and Burn Treatment, Percy Military Hospital, Clamart, France
- Department of Ophthalmology, Percy Military Hospital, Clamart, France
- acial and Oculoplastic Surgery Unit, Quinze-Vingts National Center, Paris, France
- Faculty of Medicine Pierre et Marie Curie, Sorbonne University Paris VI, France
- Assistance Publique des Hôpitaux de Paris, France
| | - A. De Faria
- Department of Ophthalmology, Percy Military Hospital, Clamart, France
| | - A. Baus
- Department of Plastic Surgery and Burn Treatment, Percy Military Hospital, Clamart, France
| | - M. Delbarre
- Department of Ophthalmology, Percy Military Hospital, Clamart, France
| | - J.V. Schaal
- Burn Center, Percy Military Hospital, Clamart, France
| | | | - E. Bey
- Department of Plastic Surgery and Burn Treatment, Percy Military Hospital, Clamart, France
| | - P. Duhamel
- Department of Plastic Surgery and Burn Treatment, Percy Military Hospital, Clamart, France
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Luo M, Li Y, Zhuo Y. Advances and Current Clinical Applications of Anterior Segment Optical Coherence Tomography Angiography. Front Med (Lausanne) 2021; 8:721442. [PMID: 34888319 PMCID: PMC8649770 DOI: 10.3389/fmed.2021.721442] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 11/01/2021] [Indexed: 12/04/2022] Open
Abstract
Optical coherence tomography angiography (OCTA) is the most relevant evolution based on optical coherence tomography (OCT). OCTA can present ocular vasculature, show detailed morphology for assessment, and quantify vessel parameters without intravenous dye agent. Research on the anterior segment OCTA (AS-OCTA) is only in its initial phase, and its advances in clinical diagnosis and treatment efficacy evaluations require a detailed comparison to traditional imaging methods. In this review of AS-OCTA, we summarize its technical features, imaging advances, current clinical applications in various eye diseases, as well as its limitations and potential future directions. AS-OCTA offers potential advantages in ophthalmic imaging, and with further development it could become a common tool in the near future.
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Affiliation(s)
- Man Luo
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Yiqing Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Yehong Zhuo
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
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An Analysis of the Progression of Conjunctivalisation after Transplantation of Cultivated Corneal Epithelium. J Ophthalmol 2021; 2021:8499640. [PMID: 34853705 PMCID: PMC8629671 DOI: 10.1155/2021/8499640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 11/03/2021] [Indexed: 11/17/2022] Open
Abstract
Purpose To analyse the recurrence of superficial neovascularisation after previous corneal surface reconstruction with cultivated corneal epithelial cells. Materials and Methods Forty-eight eyes underwent autologous transplantation of cultivated corneal epithelium to treat partial or total limbal stem cell deficiency caused by chemical or thermal injury. The carrier for the epithelial sheets was a denuded amniotic membrane. Follow-up was conducted for up to 120 months. Recurrent revascularisation (measured in terms of clock hours affected) was evaluated with slit-lamp examination and the support of confocal microscopy. Results During the long-term observation, only 7 eyes had stable epithelia with no neovascularisation from the conjunctiva. Nineteen eyes developed pathologic vessels in 1 quadrant, with additional 4 eyes developing them in 2 quadrants. Twelve patients developed subtotal or total conjunctivalisation of the corneal surface. They were referred for second cultivated epithelium transplantation (3 patients), allogenic keratolimbal transplantation (7 patients), or keratoprosthesis (2 patients). Six patients withdrew consent. The use of confocal scans of up to 100 µm in resolution enabled the detection of pathologic microvasculature originating from the conjunctiva and the exclusion of stromal vascular ingrowth. Conclusions Local ingrowth of the conjunctiva is a common complication after the transplantation of cultivated epithelial cells. Severe and progressive vascularisation inevitably leads to graft failure. However, if local ingrowth stops before reaching the central cornea, the treatment even with this complication can be considered a success.
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Ten Years of Pediatric Ocular Chemical Burn Experience in a Tertiary Eye Care Center in Turkey. Eye Contact Lens 2021; 48:175-179. [DOI: 10.1097/icl.0000000000000858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2021] [Indexed: 12/09/2022]
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Lee J, Jun JH. Ocular chemical burn associated with gel type alcohol-based hand sanitizer: A case report. Medicine (Baltimore) 2021; 100:e27292. [PMID: 34678862 PMCID: PMC8542124 DOI: 10.1097/md.0000000000027292] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 09/02/2021] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Alcohol-based hand sanitizers (ABHS) are widely used for hand hygiene due to the coronavirus disease pandemic. However, risk awareness regarding its adverse effects is lacking. We aim to report a case of ocular chemical burn that showed severe clinical presentation associated with ABHS. PATIENT CONCERNS A 5-year-old girl presented with severe left eye pain after 62% gel-type ABHS splashed into her eye. DIAGNOSIS On slit lamp examination, a near total corneal and conjunctival epithelial defect with limbal pale on the lower half of the cornea was noted. Severe ocular burn by ABHS was prominent with suspected limbal stem cell damage. INTERVENTIONS She was hospitalized and was prescribed topical medications including antibiotics, steroid eye drops with preservative-free artificial tears, and oral nonsteroidal anti-inflammatory drugs. OUTCOMES Despite intensive medical treatments, the corneal and conjunctival epithelial defects showed no improvement up to the 4th hospital day. After additional instillation of autoserum eye drops to promote epithelial healing, the corneal epithelium barely recovered from the temporal limbus. On the third week of admission, the epithelial defect was completely resolved without corneal opacity, although with minimal symblepharon in the lower fornix. CONCLUSIONS Gel-type ABHS can cause severe form of ocular chemical burn such as delayed ocular surface healing. In clinical setting, immediate and thorough rinsing of alcohol-based gel and early intensive treatment are crucial.
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Singla E, Kumar S, Rehman O, Ichhpujani P. Pressure cooker–induced autovisceration: From kitchen to emergency. TRAUMA-ENGLAND 2021. [DOI: 10.1177/14604086211046691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Domestic pressure cooker trauma leading to severe ocular injuries is generally underreported. It can have varying manifestations ranging from penetrating ocular injury to thermal burns. We report a case of pressure cooker explosion presenting as autoevisceration in one eye and thermal burn in the other eye. This case highlights the importance of the need to increase awareness and promote safety measures to help prevent such accidents.
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Affiliation(s)
- Ekta Singla
- Department of Ophthalmology, Government Medical College and Hospital, Chandigarh, India
| | - Suresh Kumar
- Department of Ophthalmology, Government Medical College and Hospital, Chandigarh, India
| | - Obaidur Rehman
- Department of Ophthalmology, Government Medical College and Hospital, Chandigarh, India
| | - Parul Ichhpujani
- Department of Ophthalmology, Government Medical College and Hospital, Chandigarh, India
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Corneal Epithelial Stem Cells-Physiology, Pathophysiology and Therapeutic Options. Cells 2021; 10:cells10092302. [PMID: 34571952 PMCID: PMC8465583 DOI: 10.3390/cells10092302] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 08/27/2021] [Accepted: 08/28/2021] [Indexed: 12/12/2022] Open
Abstract
In the human cornea, regeneration of the epithelium is regulated by the stem cell reservoir of the limbus, which is the marginal region of the cornea representing the anatomical and functional border between the corneal and conjunctival epithelium. In support of this concept, extensive limbal damage, e.g., by chemical or thermal injury, inflammation, or surgery, may induce limbal stem cell deficiency (LSCD) leading to vascularization and opacification of the cornea and eventually vision loss. These acquired forms of limbal stem cell deficiency may occur uni- or bilaterally, which is important for the choice of treatment. Moreover, a variety of inherited diseases, such as congenital aniridia or dyskeratosis congenita, are characterized by LSCD typically occurring bilaterally. Several techniques of autologous and allogenic stem cell transplantation have been established. The limbus can be restored by transplantation of whole limbal grafts, small limbal biopsies or by ex vivo-expanded limbal cells. In this review, the physiology of the corneal epithelium, the pathophysiology of LSCD, and the therapeutic options will be presented.
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Tey KY, Gan J, Foo V, Tan B, Ke MY, Schmetterer L, Mehta JS, Ang M. Role of anterior segment optical coherence tomography angiography in the assessment of acute chemical ocular injury: a pilot animal model study. Sci Rep 2021; 11:16625. [PMID: 34404833 PMCID: PMC8371111 DOI: 10.1038/s41598-021-96086-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 07/21/2021] [Indexed: 11/28/2022] Open
Abstract
To examine the use of anterior segment-optical coherence tomography angiography (AS-OCTA) in the assessment of limbal ischemia in an animal model chemical ocular injury. We conducted a prospective study using an established chemical ocular injury model in 6 rabbits (12 eyes), dividing the cornea limbus into 4 quadrants. Chemical injury grade was induced based on extent of limbal injury (0 to 360 degrees) and all eyes underwent serial slit-lamp with AS-OCTA imaging up to one month. Main outcome measure was changes in AS-OCTA vessel density (VD) comparing injured and control cornea limbal quadrants within 24 h and at one month. AS-OCTA was able to detect differences in limbal VD reduction comparing injured (3.3 ± 2.4%) and control quadrants (7.6 ± 2.3%; p < 0.001) within 24 h of ocular chemical injury. We also observed that AS-OCTA VD reduction was highly correlated with the number of quadrants injured (r = − 0.89; p < 0.001; 95% CI − 5.65 to − 1.87). Corneal vascularization was detected by AS-OCTA in injured compared to control quadrants (10.1 ± 4.3% vs 7.0 ± 1.2%; p = 0.025) at 1 month. Our animal pilot study suggests that AS-OCTA was able to detect limbal vessel disruption from various severities of acute chemical insult, and in the future, could potentially serve as an adjunct in providing objective grading of acute ocular chemical injury once validated in a clinical trial.
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Affiliation(s)
- Kai Yuan Tey
- Singapore Eye Research Institute, Singapore, Singapore
| | - Jinyuan Gan
- Duke-NUS Medical School, Singapore, Singapore
| | - Valencia Foo
- Singapore National Eye Centre, 20 College Rd, Singapore, 169856, Singapore
| | - Bingyao Tan
- Singapore Eye Research Institute, Singapore, Singapore.,SERI-NTU Advanced Ocular Engineering (STANCE) Program, Nanyang Technological University, Singapore, Singapore
| | - Meng Yuan Ke
- Singapore Eye Research Institute, Singapore, Singapore
| | - Leopold Schmetterer
- Singapore Eye Research Institute, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore.,SERI-NTU Advanced Ocular Engineering (STANCE) Program, Nanyang Technological University, Singapore, Singapore.,School of Chemical and Biomedical Engineering, Nanyang Technological University, Singapore, Singapore.,Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria.,Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria.,Institute of Molecular and Clinical Ophthalmology, Basel, Switzerland
| | - Jodhbir S Mehta
- Singapore Eye Research Institute, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore.,Singapore National Eye Centre, 20 College Rd, Singapore, 169856, Singapore
| | - Marcus Ang
- Singapore Eye Research Institute, Singapore, Singapore. .,Duke-NUS Medical School, Singapore, Singapore. .,Singapore National Eye Centre, 20 College Rd, Singapore, 169856, Singapore.
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