ABSTRACT
Ocular chemical burns are a significant cause of visual impairment. This study aims to characterize the ocular chemical burns in a southwestern Colombia referral center and identify associated factors with low vision. A retrospective cohort study was carried out based on the review of medical records of patients diagnosed with chemical eye burns who consulted the emergency ophthalmology service between January 2016 and December 2019. Descriptive statistics were performed. Associations with low vision (Best-Corrected Visual Acuity, ≥20/70 in Snellen chart) in the last follow-up appointment were identified using a multivariate logistic regression with odds ratios (OR) and 95% confidence intervals (95% CI). About 219 eyes affected by chemical burns were identified from 174 patients with a mean age of 39 years (SD ± 20), of which 57.5% (n = 100) were men. We ran a multivariate model adjusted by sex, eye wash, type of chemical, and Dua's classification. We found that the odds of low vision for patients without eyewash before the consult were 3 times the odds of those who had it (adjusted OR [aOR] = 3.5, 95% CI = 1.3-9.4) and almost 5 times for those with Dua's classification >1 (aOR = 4.7, 95% CI = 1.7-12.9). The ocular chemical burns reported in this study occurred more in young people of productive age. Acids were the principal causal agent. The association between lack of early management and the severity of the chemical burn with low vision has been highlighted. Ocular burns remain a relevant cause of consultation on the ophthalmology service in Cali, and prevention strategies are required.
Subject(s)
Burns, Chemical , Eye Burns , Humans , Male , Colombia/epidemiology , Female , Adult , Retrospective Studies , Burns, Chemical/epidemiology , Burns, Chemical/therapy , Eye Burns/epidemiology , Eye Burns/chemically induced , Eye Burns/therapy , Middle Aged , Visual Acuity , Young AdultABSTRACT
ABSTRACT Objective: To analyze the morphological and functional long-term outcomes of amniotic membrane transplantation after ocular surface chemical burns. Methods: This prospective study analyzed 7 patients who suffered from severe ocular surface burn and underwent amniotic membrane transplantation from 2015 to 2020 in Hospital de Clínicas - Universidade Federal do Paraná. Results: Out of the seven patients, six (85.7%) suffered unilateral burn and one (14.3%) suffered bilateral burn. Five of them had alkali burns (71.4%), one had acid burn (14.3%) and one suffered gunpowder fireworks burn (14.3%). Mean age was 29.4 years (±standard deviation 13.3, range 14.0 to 47.0 years). Mean visual acuity at first presentation was 1.83±0.79 logMAR (0.015 decimal) and mean VA after a follow-up of 1 year was 0.85±0.70 logMAR (0.141 decimal). The visual acuity significantly improved from 1.83±0.79 to 0.85±0.70 logMAR (p<0.05). Conclusion: Amniotic membrane transplantation is an effective adjunctive treatment in the management of ocular surface chemical burns with potential to improve the final vision outcome.
RESUMO Objetivo: Analisar os resultados morfológicos e funcionais a longo prazo do transplante de membrana amniótica após queimaduras químicas da superfície ocular. Métodos: Foi realizado um estudo prospectivo com análise de sete pacientes que sofreram queimaduras graves da superfície ocular e foram submetidos a transplante de membrana amniótica no período de 2015 a 2020 no Hospital de Clínicas da Universidade Federal do Paraná. Resultados: Dos sete pacientes, seis (85,7%) sofreram queimadura unilateral e um (14,3%) sofreu queimadura bilateral. Cinco deles sofreram queimaduras por álcali (71,4%), um por ácido (14,3%) e um por pólvora de fogo de artifício (14,3%). A média de idade foi de 29,4 anos (±desvio-padrão de 13,3, intervalo de 14,0 a 47,0 anos). A acuidade visual média na primeira apresentação foi de 1,83±0,79 logMAR (0,015 decimal) e, após 1 ano de seguimento, foi de 0,85±0,70 logMAR (0,141 decimal). A acuidade visual melhorou significativamente, de 1,83±0,79 para 0,85±0,70 logMAR (p<0,05). Conclusão: O transplante de membrana amniótica é um tratamento adjuvante eficaz no manejo de queimaduras químicas da superfície ocular com potencial para melhorar a visão final.
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Ophthalmologic Surgical Procedures/methods , Burns, Chemical/surgery , Eye Burns/surgery , Eye Burns/chemically induced , Cornea/surgery , Amnion/transplantation , Tissue Preservation , Visual Acuity , Prospective Studies , Membranes/transplantationABSTRACT
Eye burns due to the accidental application of pharmacological or nonpharmacological substances packaged in plastic dropper bottles have been described for more than three decades and continue to occur. These burns can cause potentially serious corneal injuries. We report the case of a patient who mistakenly applied salicylic acid to the right eye after confusing it with an eye lubricant, which caused him a severe corneal burn. Fortunately, after aggressive medical and surgical management (including oxygen therapy and amniotic membrane grafting), the visual results were good. We suggest conducting educational campaigns and taking legislative measures in our country to avoid packaging corrosive substances in this type of dropper bottle to reduce the risk of accidental burns.
Las quemaduras oculares por aplicación accidental de sustancias farmacológicas o no farmacológicas envasadas en frascos goteros plásticos, se han descrito desde hace más de tres décadas y siguen ocurriendo. Estas quemaduras pueden causar lesiones potencialmente graves de la córnea. Se presenta el caso de un paciente que se aplicó ácido salicílico en el ojo derecho al confundir el envase con el de un lubricante ocular, lo que le causó una grave quemadura corneal. Afortunadamente, tras un manejo médico y quirúrgico agresivo (incluida oxigenoterapia e injerto de membrana amniótica) los resultados visuales fueron buenos. Se sugiere hacer campañas educativas y adoptar normas en el país para evitar el envase de sustancias corrosivas en este tipo de frascos goteros, con el fin de disminuir el riesgo de quemaduras accidentales.
Subject(s)
Antifungal Agents/adverse effects , Corneal Injuries/chemically induced , Eye Burns/chemically induced , Salicylic Acid/adverse effects , Corneal Injuries/pathology , Corneal Injuries/therapy , Drug Labeling , Drug Packaging , Eye Burns/pathology , Eye Burns/therapy , Humans , Lubricant Eye Drops , Male , Middle Aged , Ophthalmic Solutions , PlasticsABSTRACT
Some recent studies have shown that pirfenidone (PFD) has favorable results in the healing process of the cornea. However, PFD in solution exhibits short half-life after topical application, and in this context, a liquid crystal nanoparticle system containing PFD (PFD-LCNPs) was developed. The nanoparticles were characterized by transmission electron microscopy, atomic force microscopy, small angle X-ray diffraction and polarized light microscopy. The PFD-LCNPs had particle size and zeta potential of 247.3â¯nm and -33.60â¯mV (stores at 4⯰C), respectively, and 257.5â¯nm and -46.00â¯mV (stored at 25⯰C), respectively. The pH of the formulation was 6.9 and the encapsulation efficiency was 35.9%. The in vitro release profiles indicated that PFD sustained release from PFD-LCNPs for up to 12â¯h. In vitro study of ocular irritation (HET-CAM test) concluded that components of the formulation are well tolerated for ocular administration. Corneal re-epithelialization time after chemical burning was significantly reduced in rabbits treated with PFD-loaded LCNPs when compared to the group treated with a vehicle. In addition, the anti-inflammatory action of pirfenidone was observed by reducing myeloperoxidase activity (MPO) and inflammatory cells in the histology of the tissues of animals treated with PFD-LCNPs. These findings indicated that the PFD-LCNPs might have the potential for effective ocular drug delivery.
Subject(s)
Analgesics/administration & dosage , Anti-Inflammatory Agents/administration & dosage , Burns, Chemical/drug therapy , Eye Burns/drug therapy , Liquid Crystals , Nanoparticles/administration & dosage , Pyridones/administration & dosage , Administration, Ophthalmic , Analgesics/pharmacokinetics , Animals , Anti-Inflammatory Agents/pharmacokinetics , Burns, Chemical/metabolism , Burns, Chemical/pathology , Chick Embryo , Chorioallantoic Membrane/drug effects , Cornea/drug effects , Cornea/metabolism , Cornea/pathology , Drug Delivery Systems , Drug Liberation , Drug Stability , Eye Burns/chemically induced , Eye Burns/metabolism , Eye Burns/pathology , Female , Particle Size , Peroxidase/metabolism , Pyridones/pharmacokinetics , RabbitsABSTRACT
Purpose: The aims of this study were (1) to determine the efficacy of adenovirus vector serotype 5 (Ad) encoding human soluble VEGF receptor 1 (s-VEGFR1) gene transfer to the lacrimal gland (LG); (2) to investigate whether expression of s-VEGFR1 prevents corneal neovascularization (CNV) induced by alkali burns; and (3) to evaluate the safety of the procedure. Methods: AdVEGFR1 vectors (25 µL, 1 × 1010 pfu/mL) were injected in the right LGs of rats and were compared with AdNull vector (25 µL, 1 × 1010 pfu/mL) or 25 µL of saline (Control) before cornea alkali burns with 1 M NaOH. After 7 days, CNV was documented at the slit lamp. Tear secretion was measured with phenol red threads. The animals were tested for s-VEGFR1 mRNA and protein in the LG by quantitative (q)PCR and immunohistochemistry staining, respectively. qPCR was used to compare the mRNA levels of IL-1ß, IL-6, and TNF-α in the LG and ipsilateral trigeminal ganglion (TG). Results: Ad-VEGFR1 transfected 83% (10/12) of the rats. VEGFR1 was present in LG acinar cells. CNV was prevented in 9 of 12 animals in the Ad-VEGFR1 group, compared with the Ad-Null (3:10) and Control groups (1:10) (P = 0.0317). The tear secretion and cytokine mRNA levels in the LG and TG were similar in all three groups (P > 0.05). Conclusions: Adenoviral vector gene transfer was safe for LG structure and function. The LG as the target tissue showed local expression of human s-VEGFR1, and CNV was prevented in most of the eyes exposed to alkali burns.
Subject(s)
Adenoviridae/genetics , Corneal Neovascularization/prevention & control , Genetic Therapy , Genetic Vectors , Lacrimal Apparatus/metabolism , Vascular Endothelial Growth Factor Receptor-1/genetics , Animals , Burns, Chemical/prevention & control , Corneal Neovascularization/chemically induced , Cytokines/metabolism , Eye Burns/chemically induced , Gene Expression , Humans , Male , RNA, Messenger/genetics , Rats , Rats, Wistar , Real-Time Polymerase Chain Reaction , Sodium Hydroxide , Transfection , Vascular Endothelial Growth Factor A/metabolismABSTRACT
An outbreak of skin burn and ocular damage by calcium oxide in swines is reported. The outbreak occurred in a rural property located in the municipality of Iuiu, Western Bahia, during the transport of 60 pigs from a recreation farm to a fattening farm. The observed macroscopic lesions were erythematous areas; formation of papules, vesicles, and in some cases, there was the formation of firm, parched, high brown plaques and in other cases detachment and loss of skin. His eyes were dull. Histological analysis of the skin revealed areas of necrosis of focally extensive clotting of the epidermis, and dermis, delimited in the paniculus, by cellular debris and rare neutrophils. Corneal necrosis with perforated ulcer formation, superficial epithelial necrosis, edema, and neutrophil infiltration of the cornea adjacent to the ulcer were revealed in the eye.(AU)
Descreve-se um surto de queimadura de pele e lesão ocular por óxido de cálcio (cal virgem) em suínos. O surto ocorreu em uma propriedade rural localizada no município de Iuiu, região Oeste da Bahia, durante o transporte de 60 suínos de uma granja de recria para uma granja de engorda. Macroscopicamente foi evidenciado que na pele dos suínos havia áreas eritematosas, formação de pápulas, vesículas, e em alguns casos havia a formação de placas elevadas marrom firmes, ressequidas e em outros casos desprendimento e perda da pele. Os olhos estavam opacos. Na microscopia da pele observaram-se áreas de necrose de coagulação focalmente extensa da epiderme, e derme, delimitadas no panículo, por restos celulares e raros neutrófilos. No olho observou-se necrose da córnea com formação de úlcera perfurada, necrose do epitélio superficial, edema e infiltração de neutrófilos na córnea adjacente a úlcera.(AU)
Subject(s)
Animals , Swine/injuries , Burns, Chemical/veterinary , Eye Burns/chemically induced , Eye Burns/veterinary , Calcium OxideABSTRACT
An outbreak of skin burn and ocular damage by calcium oxide in swines is reported. The outbreak occurred in a rural property located in the municipality of Iuiu, Western Bahia, during the transport of 60 pigs from a recreation farm to a fattening farm. The observed macroscopic lesions were erythematous areas; formation of papules, vesicles, and in some cases, there was the formation of firm, parched, high brown plaques and in other cases detachment and loss of skin. His eyes were dull. Histological analysis of the skin revealed areas of necrosis of focally extensive clotting of the epidermis, and dermis, delimited in the paniculus, by cellular debris and rare neutrophils. Corneal necrosis with perforated ulcer formation, superficial epithelial necrosis, edema, and neutrophil infiltration of the cornea adjacent to the ulcer were revealed in the eye.(AU)
Descreve-se um surto de queimadura de pele e lesão ocular por óxido de cálcio (cal virgem) em suínos. O surto ocorreu em uma propriedade rural localizada no município de Iuiu, região Oeste da Bahia, durante o transporte de 60 suínos de uma granja de recria para uma granja de engorda. Macroscopicamente foi evidenciado que na pele dos suínos havia áreas eritematosas, formação de pápulas, vesículas, e em alguns casos havia a formação de placas elevadas marrom firmes, ressequidas e em outros casos desprendimento e perda da pele. Os olhos estavam opacos. Na microscopia da pele observaram-se áreas de necrose de coagulação focalmente extensa da epiderme, e derme, delimitadas no panículo, por restos celulares e raros neutrófilos. No olho observou-se necrose da córnea com formação de úlcera perfurada, necrose do epitélio superficial, edema e infiltração de neutrófilos na córnea adjacente a úlcera.(AU)
Subject(s)
Animals , Swine/injuries , Burns, Chemical/veterinary , Eye Burns/chemically induced , Eye Burns/veterinary , Calcium OxideABSTRACT
Purpose: To investigate the effect of naringenin eye drops in corneal neovascularization induced by alkali (1 N NaOH) burn in mice. Methods: Corneal neovascularization in the right eye of male Swiss mice was induced by alkali. Treatment with naringenin eye drops (0.08-80 µg; 8 µL of 0.01-10 g/L solution) or vehicle (saline) started 2 days before corneal neovascularization was induced and was performed twice a day. Mice were treated up until the time animals were euthanized and cornea tissue was collected for testing, which was 2, 4, and 6 hours after alkali stimulus for cytokine and antioxidant capacity measurements, and 3 and/or 7 days after alkali stimulus for the assessment of corneal epithelial thickness and neovascularization, neutrophil, and macrophage recruitment, and vascular endothelial growth factor (Vegf), platelet-derived growth factor (Pdgf), matrix metalloproteinase-14 (Mmp14), and pigment epithelium-derived factor (Pedf) mRNA expression. Results: Naringenin eye drops inhibited alkali burn-induced neutrophil (myeloperoxidase activity and recruitment of Lysm-GFP+ cells) and macrophage (N-acetyl-ß-D glucosaminidase activity) recruitment into the eye, decrease in epithelial thickness, and neovascularization in the cornea. Further, naringenin inhibited alkali-induced cytokine (IL-1ß and IL-6) production, Vegf, Pdgf, and Mmp14 mRNA expression, and the reduction of ferric reducing antioxidant power and Azinobis-(3-Ethylbenzothiazoline 6-Sulfonic acid) radical scavenging capacity as well as increased the reduced glutathione and protein-bound sulfhydryl groups levels. Conclusions: Collectively, these results indicate that naringenin eye drops are protective in alkali-induced corneal burn by inhibiting leukocyte recruitment, the proangiogenic factor expression, inflammatory cytokine production, and loss of antioxidant defenses.
Subject(s)
Antioxidants/metabolism , Corneal Neovascularization/drug therapy , Cytokines/metabolism , Epithelium, Corneal/metabolism , Flavanones/administration & dosage , Alkalies/toxicity , Animals , Burns, Chemical/complications , Corneal Neovascularization/metabolism , Corneal Neovascularization/pathology , Disease Models, Animal , Epithelium, Corneal/drug effects , Epithelium, Corneal/pathology , Estrogen Antagonists/administration & dosage , Eye Burns/chemically induced , Male , Mice , Microscopy, Confocal , Ophthalmic SolutionsABSTRACT
Purpose: Limbal epithelial stem cells (LSCs), located in the basal layer of the corneal epithelium in the corneal limbus, are vital for maintaining the corneal epithelium. LSCs have a high capacity of self-renewal with increased potential for error-free proliferation and poor differentiation. To date, limited research has focused on unveiling the composition of the limbal stem cell niche, and, more important, on the role the specific stem cell niche may have in LSC differentiation and function. Our work investigates the composition of the extracellular matrix in the LSC niche and how it regulates LSC differentiation and function. Methods: Hyaluronan (HA) is naturally synthesized by hyaluronan synthases (HASs), and vertebrates have the following three types: HAS1, HAS2, and HAS3. Wild-type and HAS and TSG-6 knockout mice-HAS1-/-;HAS3-/-, HAS2Δ/ΔCorEpi, TSG-6-/--were used to determine the importance of the HA niche in LSC differentiation and specification. Results: Our data demonstrate that the LSC niche is composed of a HA rich extracellular matrix. HAS1-/-;HAS3-/-, HAS2Δ/ΔCorEpi, and TSG-6-/- mice have delayed wound healing and increased inflammation after injury. Interestingly, upon insult the HAS knock-out mice up-regulate HA throughout the cornea through a compensatory mechanism, and in turn this alters LSC and epithelial cell specification. Conclusions: The LSC niche is composed of a specialized HA matrix that differs from that present in the rest of the corneal epithelium, and the disruption of this specific HA matrix within the LSC niche leads to compromised corneal epithelial regeneration. Finally, our findings suggest that HA has a major role in maintaining the LSC phenotype.
Subject(s)
Cell Differentiation/physiology , Cellular Microenvironment/physiology , Epithelium, Corneal/metabolism , Hyaluronic Acid/metabolism , Limbus Corneae/cytology , Stem Cell Niche/physiology , Stem Cells/metabolism , Animals , Burns, Chemical/metabolism , Disease Models, Animal , Eye Burns/chemically induced , Glucuronosyltransferase/metabolism , Hyaluronan Synthases , Hyaluronic Acid/genetics , Immunohistochemistry , Mice , Mice, Inbred C57BL , Mice, Knockout , Mice, Transgenic , Microscopy, Confocal , Microscopy, Electron, Transmission , RNA, Messenger/genetics , Real-Time Polymerase Chain Reaction , Sodium Hydroxide , Wound Healing/physiologyABSTRACT
PURPOSE: To evaluate the efficacy of mannitol solution as a decontamination agent on the chemical burn of the human corneas. METHODS: Eight donor corneas from an eye bank were exposed to 25µl of 2.5% hydrofluoric acid (HF) solution on a filter paper for 20s. Three eyes were rinsed with 1000ml of mannitol 20% for 15min immediately after removal of the filter paper, 3 other were rinsed with sodium chloride (NaCl) 0.9% (1000ml for 15min) and two eyes were not rinsed. Microstructural changes were monitored in the time domain by optical coherence tomography (OCT) imaging for 75min. RESULTS: NaCl reduced the penetration depth to approximately half the thickness of the cornea at 15min; scattering within the anterior cornea was higher than that for the unrinsed eye. With mannitol, no increased scattering was observed in the posterior part of the corneal stroma within a time period of 1h after rinsing. OCT images revealed low-scattering intensity within the anterior stroma at the end of the rinsing period. CONCLUSION: In eye bank human corneas, mannitol proved to be an efficient agent to decontaminate HF burn.
Subject(s)
Burns, Chemical/diagnostic imaging , Corneal Injuries/diagnostic imaging , Decontamination/methods , Eye Burns/diagnostic imaging , Hydrofluoric Acid/adverse effects , Mannitol/therapeutic use , Pharmaceutical Solutions/therapeutic use , Therapeutic Irrigation/methods , Burns, Chemical/etiology , Burns, Chemical/therapy , Corneal Injuries/chemically induced , Corneal Injuries/therapy , Eye Burns/chemically induced , Eye Burns/therapy , Humans , In Vitro Techniques , Sodium Chloride/therapeutic use , Tomography, Optical CoherenceABSTRACT
PURPOSE: To describe and further analyze the long-term results in visual acuity (VA), anatomical retention, and rate of complications from patients who underwent Boston keratoprosthesis (B-Kpro) type 1 after ocular chemical burns in the Dominican Republic. METHODS: A retrospective review of 42 eyes (22 OD:20 OS) of 36 patients who underwent B-Kpro type 1 implantation after severe ocular burn at Hospital Elías Santana in Santo Domingo, Dominican Republic, between April 2006 and October 2014, were included. RESULTS: Demographics, VA, anatomical retention, and the rates of postoperative complications and concurrent surgeries were evaluated. CONCLUSIONS: The excellent anatomical retention rates and visual outcomes presented in this study support the remarkable capability of B-Kpro type 1 to restore functional VA in eyes with severe chemical injuries. However, strict control of the postoperative complications is necessary for long-term success. In conclusion, the use of a B-Kpro type 1 after severe chemical burn is a viable option in patients otherwise condemned to the high risk of failure associated with conventional corneal grafts.
Subject(s)
Bioprosthesis , Burns, Chemical/surgery , Corneal Diseases/surgery , Eye Burns/chemically induced , Prosthesis Implantation , Adult , Burns, Chemical/physiopathology , Corneal Diseases/physiopathology , Female , Graft Survival/physiology , Humans , Male , Middle Aged , Postoperative Complications , Prostheses and Implants , Retrospective Studies , Visual Acuity/physiology , Young AdultABSTRACT
PURPOSES: To assess the effects of 0.5% ketorolac tromethamine without preservatives on the expression of iNOS and MMP-9 in alkali burn ulcers. METHODS: Twelve eyes of 120-day-old male rabbits were treated (TG) every 6 h with 0.5% ketorolac tromethamine and 12 other eyes were treated with saline solution (CG), immediately after the occurrence of ulcers by 1 M sodium hydroxide (NaOH). Re-epithelialization was monitored using fluorescein every 6 h. After 24 h, six corneas (n=6) of each group were collected (M1). The others (n=6) were collected after reepithelialization (M2). At both moments, the inflammatory infiltrate and the conditions of the newly formed epithelium were histologically analyzed. iNOS and MMP-9 were evaluated by immunohistochemistry. RESULTS: Mean epithelialization time in TG was 55 ± 0.84 h. In CG, it was 44 ± 1.06 h (p=0.001). At M1, corneas of TG had lower inflammatory exudation compared with (p <0.001). At M2, TG revealed discrete inflammatory exudation (p>0.05) and lower numbers of epithelial layers compared with CG. The mean iNOS in stromal cells did not differ in TG over both moments compared with CG (p>0.05) At M2, the central corneal region expressed more iNOS in both groups compared with the peripheral region. No significant differences were observed in iNOS scores of epithelial immunostaining between the groups and across M1 and M2 (p=0.69). Epithelial immunostaining scores for MMP-9 did not differ in TG compared with CG (p=0.69). The average immunostaining score of MMP-9 in stromal cells showed no differences between groups or moments. There was no correlation between immunostaining of iNOS and MMP-9 or between the amount of inflammatory cells and immunostaining of iNOS. CONCLUSIONS: Use of 0.5% keratolac tromethamine reduced inflammation and delayed reepithelialization in a cornea alkali burn model without impacting the expression of iNOS or MMP-9.
Subject(s)
Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Corneal Ulcer/drug therapy , Ketorolac Tromethamine/therapeutic use , Matrix Metalloproteinase 9/drug effects , Nitric Oxide Synthase Type II/drug effects , Ophthalmic Solutions/therapeutic use , Re-Epithelialization/drug effects , Alkalies , Animals , Anti-Inflammatory Agents, Non-Steroidal/pharmacology , Burns, Chemical/drug therapy , Cornea/drug effects , Cornea/pathology , Corneal Ulcer/chemically induced , Corneal Ulcer/pathology , Eye Burns/chemically induced , Eye Burns/drug therapy , Immunohistochemistry , Ketorolac Tromethamine/pharmacology , Male , Ophthalmic Solutions/pharmacology , Rabbits , Reproducibility of Results , Time Factors , Treatment OutcomeABSTRACT
BACKGROUND: To study the effect of topical administration of a fusion protein (PF-MC) made up of N-terminal portion of the protease inhibitor Trappin-2 (which is a substrate of transglutaminasa-2) and SLPI (protein with anti-inflammatory, anti-bacterial and anti-viral ability), in an animal model of corneal inflammation and angiogenesis. METHODS: An alkali injury was produced with a filter paper of 3 mm with 1 N NaOH during 40 seconds on the right cornea of 36 male Sprague Dawley rats, under general anesthesia. Animals were divided into three groups according to treatment. Group 1 was treated with 10 ul of PF-MC (200 ug/ml; n = 12), Group 2, with 10 ul of SLPI (200 ug/ml; n = 12) and Group 3 was treated with buffer (10 ul; n = 12) topically administered four times a day for up to 7 days. Half of the animals were sacrificed at day 3 before making a re-epithelialization time analysis with fluorescein staining at 18 and 24 hours. In the remaining animals corneal opacity was studied and digital photographs were taken at day 7 before doing euthanasia. Eyes were processed for histology and immunofluorescence. RESULTS: Corneal ulcerated area was significantly lower in PF-MC treated animals compared to SLPI and buffer-treated animals at 18 hours and 24 hours postinjury. A clear cornea and fundus red reflex was only found among PF-MC treated animals. Histological analysis revealed a stratified corneal epithelium with at least three layers in all PF-MC animals at day 7. In this group there was a reduced number of PMNs in the corneal stroma at 3 and 7 days of follow-up. Besides, corneal neovascularization was much more extended in SLPI and Buffer animals than in animals treated with PF-MC. CONCLUSIONS: The binding of SLPI with Cementoin to transglutaminase seems to be an effective strategy to treat corneal inflammation and angiogenesis.
Subject(s)
Burns, Chemical/drug therapy , Corneal Neovascularization/drug therapy , Eye Burns/chemically induced , GTP-Binding Proteins/genetics , Keratitis/drug therapy , Recombinant Fusion Proteins/administration & dosage , Secretory Leukocyte Peptidase Inhibitor/genetics , Transglutaminases/genetics , Administration, Topical , Animals , Burns, Chemical/metabolism , Burns, Chemical/pathology , Cell Count , Corneal Neovascularization/metabolism , Corneal Neovascularization/pathology , Disease Models, Animal , Epithelium, Corneal/physiology , Fluorescent Antibody Technique, Indirect , Keratitis/metabolism , Keratitis/pathology , Male , Protein Glutamine gamma Glutamyltransferase 2 , Rats , Rats, Sprague-Dawley , Re-Epithelialization , Vascular Endothelial Growth Factor A/metabolismSubject(s)
Amnion , Artificial Organs , Burns, Chemical/surgery , Cornea , Corneal Diseases/surgery , Eye Burns/chemically induced , Prostheses and Implants , Adult , Aged, 80 and over , Burns, Chemical/physiopathology , Corneal Diseases/physiopathology , Humans , Male , Prosthesis Implantation , Tissue Scaffolds , Tomography, Optical Coherence , Visual Acuity/physiologyABSTRACT
PURPOSE: The aim of this study was to compare the outcome of conjunctival limbal transplantation with and without the use of amniotic membrane (AM) transplantation for the treatment of limbal deficiency after chemical burns to the eyes. METHODS: This is a retrospective, comparative, interventional case series that included 34 eyes (34 patients) with total limbal deficiency after chemical burns, who were submitted to conjunctival limbal transplantation. Two groups were formed: group 1 (15 eyes) limbal transplantation associated with AM transplantation and group 2 (19 eyes) only limbal transplantation. Success and failure rates, epithelialization time, and visual acuity were compared between the 2 groups. RESULTS: The mean follow-up period was 19.71 ± 5.6 months in group 1 and 18.26 ± 7.78 months in group 2. The proportion of conjunctival limbal autograft and living-related conjunctival limbal allograft was similar in both groups (P = 0.914). Time until complete epithelialization of the corneal surface was significantly longer in group 1 (P = 0.007). Graft survival was similar in both groups (P = 0.581). Failure rate was also similar in both groups (P = 0.232). The most common cause of failure was transplanted stem cell depletion in group 1 (20% of cases) and rejection in group 2 (10.5%). The visual acuity improved postoperatively in 12 eyes (80%) in group 1 and 16 (84.2%) in group 2 (P = 0.430). CONCLUSIONS: Results with the use of AM associated with conjunctival limbal transplantation in ocular surface reconstruction were similar to those obtained with limbal transplantation alone. Both techniques were found to be satisfactory for ocular surface reconstruction in patients with total limbal deficiency after chemical burns.
Subject(s)
Burns, Chemical/surgery , Conjunctiva/cytology , Corneal Diseases/surgery , Epithelial Cells/transplantation , Eye Burns/chemically induced , Limbus Corneae/pathology , Stem Cell Transplantation , Adolescent , Adult , Allografts , Amnion/transplantation , Burns, Chemical/physiopathology , Child , Child, Preschool , Corneal Diseases/physiopathology , Eye Burns/pathology , Female , Humans , Living Donors , Male , Middle Aged , Prognosis , Retrospective Studies , Stem Cells/pathology , Transplantation, Autologous , Visual Acuity/physiologyABSTRACT
PURPOSE: To report the outcomes of Boston type I keratoprosthesis (BKPro) in the management of ocular burn injuries. METHODS: This was a prospective study including all cases of BKPro implantation for ocular burns at the External Diseases and Cornea Service of the Federal University of São Paulo, between February 2008 and February 2010. Ten patients (10 eyes) were enrolled. Procedures performed to manage ocular injury were identified, and data were collected regarding patients' ocular history, surgical procedure(s) performed, and postoperative outcomes, including visual acuity, retention, complications and required surgical procedures. RESULTS: A total of 11 Type 1 BKPro were implanted in 10 eyes of 10 patients. The mean follow-up period was 25.7 ± 10.8 months. Preoperative best-corrected visual acuity (BCVA) ranged from count fingers to light perception. Postoperative BCVA was better than 20/200 in 90% of the patients and better than 20/60 in 60% of the patients. The overall BKPro retention rate was 90%. The most common complications were retroprosthetic membrane formation (50%) and persistent corneal epithelial defect evolving to corneal melting (40%). Patients who underwent ocular surface procedures such as limbal transplantation prior to BKPRo implantation had a lower incidence of corneal melting/thinning (p = 0.07), although this was not statistically significant. CONCLUSION: The anatomical and functional results identified in this study support the use of BKPro in managing bilateral limbal stem cell deficiency secondary to ocular burns.
Subject(s)
Artificial Organs , Bioprosthesis , Burns, Chemical/surgery , Corneal Diseases/surgery , Eye Burns/chemically induced , Prosthesis Implantation , Adult , Alkalies , Corneal Diseases/chemically induced , Eye Burns/surgery , Female , Follow-Up Studies , Humans , Male , Middle Aged , Postoperative Complications , Prospective Studies , Treatment Outcome , Visual Acuity/physiologyABSTRACT
Introducción: Aproximadamente un tercio de las cegueras infantiles son debidas a los traumatismos, siendo la principal causa de déficit visual y ceguera monocular en ninos. caso clínico: Se reporta el caso de un preescolar masculino de 2 años de edad quien presentó úlcera escleral en ojo izquierdo secundaria a quemadura química por pila de reloj cuyo motivo de consulta fue contacto con detergente, con cicatrización dificultosa debido a cuerpo extraño mineral retenido en fondo de saco conjuntival inferior durante aproximadamente un mes, contando desde el ingreso al área pediátrica. conclusión: Se reporta un caso inusual de úlcera escleral. Hasta el momento no se han reportado otros casos de úlcera escleral secundaria a quemadura química por pila de reloj y por objetos retenidos en fondo de saco conjuntival inferior, resaltando el manejo diagnóstico y la demora en la extracción del cuerpo extraño, representando una emergencia oftalmológica.
Introduction: Approximately one-third of childhood blindness is due to trauma, representing the leading cause of visual impairment and monocular blindness in children. case report: The patient is a 2 year old preschool boy, who presented scleral ulcer in his left eye secondary to chemical burn caused by watch battery. The reason for seeking medical care was difficult healing caused by a mineral foreign body retained in the lower conjunctival sac after the patient came in contact with detergent one month before the pediatric consultation. Discussion: An unusual case of scleral ulcer was reported. So far, no other similar cases have been reported. The diagnosis process and the delay for the removal of the foreign body are emphasized in this serious ophthalmologic emergency.
Subject(s)
Humans , Male , Child, Preschool , Eye Foreign Bodies/complications , Scleral Diseases/chemically induced , Eye Burns/chemically induced , Eye Burns/therapy , Burns, Chemical , Conjunctiva , Eye Injuries/chemically induced , Alkaline Batteries/adverse effectsABSTRACT
PURPOSE: To evaluate the efficacy and safety of subconjunctival injection of triamcinolone in the treatment of acute ocular alkali burn in rabbits. METHODS: Two groups of 5 rabbits were subjected to alkali burn (1 N NaOH). One group was treated with 1 subconjunctival injection of 0.3 mL of triamcinolone and the other with 1 subconjunctival injection of 0.3 mL of 0.9% saline. The affected corneas were observed for vascularization and opacity approximately 10 minutes after the burn and also after 7, 14, and 21 days. Photographs were taken for observation and statistical analyses. At all time intervals, the corneas were classified according to predetermined scores. Twenty-one days after the treatment, the animals were anesthetized, and their eyes were enucleated and processed for histopathology. RESULTS: Greater vascularization and opacity appeared in the animals that were treated with saline than in those treated with subconjunctival triamcinolone (vascularization: 7 days, P = 0.0107; 14 days, P = 0.0099; and 21 days, P = 0.0088; opacity: 7 days, P = 0.0079; 14 days, P = 0.0112; and 21 days, P = 0.0255). These results were also compatible with the morphological and statistical analyses, which revealed a more intense inflammatory process in the group treated with saline (P = 0.0317). No complications, such as corneal melting, perforation, or infection, were observed. CONCLUSIONS: Subconjunctival injection of triamcinolone may be a therapeutic option for the treatment of acute ocular burn because it reduced the corneal inflammatory process, opacity, and vascularization, with no apparent clinical changes in the general state of the animal.
Subject(s)
Alkalies/adverse effects , Burns, Chemical/drug therapy , Eye Burns/drug therapy , Glucocorticoids/administration & dosage , Triamcinolone/administration & dosage , Acute Disease , Administration, Ophthalmic , Animals , Cornea/drug effects , Corneal Injuries , Corneal Neovascularization/chemically induced , Corneal Neovascularization/pathology , Disease Models, Animal , Eye Burns/chemically induced , Eye Burns/pathology , Injections , RabbitsABSTRACT
PURPOSE: Salivary gland transplantation has been a promising alternative for the treatment of dry eye syndrome. In this article, we describe the results of an autotransplant procedure of labial salivary glands in the upper conjunctival fornix of patients with severe dry eye. METHODS: A total of 14 eyes from 14 patients presenting with Stevens-Johnson syndrome and chemical burns were prospectively analyzed after surgery (average follow-up of 14 months). We evaluated their underlying symptoms, visual acuity, biomicroscopy, Schirmer's test, break-up time, and need for lubricants before and after transplantation. RESULTS: All patients expressed improvement in their ocular discomfort. Nine eyes showed a slight best-corrected visual acuity improvement, while the vision of the remainder stayed stable. Corneal staining, present in all patients before surgery, was persistent in only four patients, but in a reduced area. Schirmer's test and break-up time showed significant increase in all patients (p < 0.05). In 71% of the patients, the use of lubricants was reduced. CONCLUSION: Labial salivary gland transplantation can improve the life quality of patients with compromised ocular surfaces who suffer from severe dry eye syndrome.