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Hamed Anwar, Henrike Westekemper, Nina Wagner, Klaus-Peter Steuhl, Daniel Meller, Francisco C Figueiredo; Long-term outcomes following amniotic membrane transplantation for the management of acute ocular chemical burn.. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):726.
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Ocular chemical injury can potentially cause limbal stem cell deficiency (LSCD) resulting in long-term debilitated vision. Amniotic membrane transplantation (AMT) has the ability to promote epithelialisation, reduce inflammation and restore ocular surface integrity. This study reports the morphological and functional outcomes of patients with ocular chemical injury who received AMT.<br />
Retrospective analysis of all patients who received AMT for the management of acute ocular chemical burn between 1998 and 2008 at the Royal Victoria Infirmary Hospital, Newcastle University, United Kingdom and University of Duisburg-Essen, Germany. Seventy-two eyes of 54 consecutive patients were included in this study. Visual acuity, degree of ocular surface burn (Dua- or Roper-Hall classifications), medical and surgical management, and long-term visual outcomes were investigated.
Mean age of patients was 37.3 (±SD 11.6, range 12.9-59.6) years and mean follow-up time was 36.4 (median 18.5; range 1.32-117.3) months. Using Roper-Hall or Dua’s classification, 20 eyes had grades I-III burns and fifty-two eyes had grade IV burn (Dua: n=9 IV°, n=32 V°, n=11 VI°). In 37 eyes (51.4%), AMT was applied within the first 6 days after injury. Twenty-seven eyes (37.5%) required more than one AMT due to persistent epithelial defect.<br /> LSCD occurred in 55 eyes (partial, 32 eyes; total, 23 eyes). Twenty-nine eyes (40.3%) reached a LogMAR best-corrected visual acuity of 0.2 (0.63 decimal) or better.
Long-term analysis revealed that AMT is an effective adjunctive treatment in the management of acute ocular chemical burns to restore ocular surface integrity and regain vision. AMT offered the possibility of improvement to partial LSCD and benefits vision in those with Dua’s grade IV burn. However, in severe ocular burns (Dua’s grade V and VI), AMT did not prevent LSCD and cannot restore vision in all cases. These eyes frequently require further surgical procedures such as limbal stem cell transplantation and penetrating keratoplasty for visual rehabilitation.
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