Clinical Spectrum and Treatment Approaches in Corneal Burns

Abstract

Objectives:To evaluate the clinical findings, treatment modalities and long-term prognosis of chemical and thermal burns of the cornea.Materials and Methods:Twenty-one patients (27 eyes) who were followed at two centers for corneal chemical and thermal burns between 2001 and 2013 were included. Eyes were grouped into four grades according to the severity of burn using Roper-Hall classification. Age, gender, type of burn, follow-up duration, corrected visual acuity before and after treatment, treatment modalities and complications were recorded. Patients received medical treatment or combined surgical treatment including amniotic membrane transplantation (AMT), conjunctivolimbal autograft/allograft (CLAU/CLAL) transplantation, keratolimbal allograft (KLAL) or penetrating keratoplasty (PKP).Results:Patients had a mean age of 27.1±15.5 years (range, 6 months-56 years) and were followed for a mean 63.2±58.6 weeks (4-160 weeks). Significant improvement was achieved with medical treatment alone in patients with grade I (4 eyes) and 2 burns (8 eyes). Patients with grade III burns (11 eyes) underwent CLAU (6 eyes), combined AMT/CLAU (3 eyes), AMT/CLAL (1 eye), or CLAL+PKP (1 eye), while patients with grade IV burns (4 eyes) had keratectomy+CLAL/AMT (1 eye), keratectomy+CLAL+PKP after recurrence with CLAU/AMT (1 eye), CLAU+PKP (1 eye), and AMT/KLAL+PKP (1 eye). All patients except the latter showed ocular surface stabilization with these procedures.Conclusion:Ocular burns cause severe impairment of the ocular surface. It is possible to achieve good results with appropriate medical treatment and surgeries including ocular surface reconstruction.

Clinical Characteristics and Severity Distribution of Tertiary Eye Center Attendance by Ocular Chemical Injury Patients

“…However, surgical treatment is required in patients with high-grade LSCD cases. 19,33 In the present study, almost half the eyes developed LSCD, and one third of these eyes required LSCT. The relationship between injury grade and LSCD was statistically significant ( P <0.001).…”

“…15 In brief, according to the effect mechanisms of the causative agents, high-grade burns mostly occur with alkaline agents. Muftuoglu et al 19 reported that 48.1% of alkali burn patients were high-grade (grade 4–6). 19 Nevertheless, in the present study, no statistically significant relationship between injury grade and agent type was demonstrated.…”

Biomechanical Modulation Therapy—A Stem Cell Therapy Without Stem Cells for the Treatment of Severe Ocular Burns

“… 52 , 65 Acid injuries typically cause protein coagulation and precipitation in the epithelium, forming a barrier that further limits penetration of the burning agent deeper into the eye. 66 , 67 Corneal injuries caused by thermal agents (e.g., resulting from exposure to scalding liquids, direct flame, or burning items) 68 and radiation exposure (e.g., UV light) 69 tend to be rarer and less severe. However, and similar to chemical injuries, thermal and radiation damage to the cornea can result in further stiffening at later stages due to tissue contracture and fibrosis.…”

Evaluation and Management of Ocular Traumas

“…The type of chemical involved and the exposure time are the most important information to start treatment. The ischemia in the limbal area may give a clue about the severity and the extent of the injury as well as the estimated visual function [16]. Alkalis can cause irreversible damage to the eye, in between 5 and 15 minutes, and many are considered the most common cause of ocular chemical burns [16][17][18].…”

“…The ischemia in the limbal area may give a clue about the severity and the extent of the injury as well as the estimated visual function [16]. Alkalis can cause irreversible damage to the eye, in between 5 and 15 minutes, and many are considered the most common cause of ocular chemical burns [16][17][18]. The assessment of severity involves three factors-damage to the lids and adnexes, degree of limbal ischemia, and the degree of acute corneal stromal opacification [19].…”