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Diane T. Chang, David S. Chu, Bradford L. Tannen; Short and Long-term Outcomes of Amniotic Membrane Grafting in Acute Corneal Burns. Invest. Ophthalmol. Vis. Sci. 2011;52(14):5161.
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Burn injuries produce extensive damage to the ocular surface epithelium, cornea, anterior segment, and limbal stem cells, often resulting in permanent visual impairment. Amniotic membrane grafting (AMG) may facilitate epithelialization and reduce inflammation, vascularization and scarring. This study investigates the short and long-term outcomes of AMG in acute corneal burns.
Retrospective review from August 2001 to January 2007 identified 8 eyes of 6 patients that received AMG for acute corneal burns. Burn severity was graded from I-IV according to the Roper-Hall criteria. Outcome measures were (1) visual acuity, (2) time to epithelialization, (3) symptomatic relief, (4) formation of symblepharon, and (5) corneal vascularization. Short term outcomes were measured 1 month after injury and long term outcomes were measured when eyes stabilized.
All patients were male with mean age 43.2 ± 11.8 years. Four eyes had grade II burns, 1 eye had a grade III burn and 3 eyes had grade IV burns. A total of 10 AMGs were performed 7.3 ± 8.5 days after injury. Additional surgery was required in 3 eyes. In the short term, vision improved significantly in grade II burns compared to grade III and IV burns (6.8 ± 1.0 lines vs. 1.0 ± 1.7 lines; p=0.0018). Epithelial defects also healed significantly faster in grade II burns (22.8 ± 6.7 days vs. 64.0 ± 5.0 days; p=0.017). Two eyes with grade IV burns had persistent epithelial defects requiring further surgery. Symptomatic relief occurred immediately after AMG in all eyes. Symblepharon formed in 2 eyes, both with grade IV burns. Corneal vascularization occurred in 2 of 4 eyes with grade II burns and in all eyes with grade III and IV burns. In the long-term (27.6 ± 22.2 months), stabilization of the corneal surface and final visual acuity of 20/20 to 20/50 was achieved in all but 1 eye with a grade IV burn.
Based on historical data, AMG appears to be superior in all outcome measures compared to medical management alone in the treatment of acute corneal burns. Our short-term results suggest that AMG improves outcomes in grade II corneal burns. In addition, our long-term results suggest that AMG may stabilize the corneal surface prior to further surgical intervention and improve final visual outcomes in patients with grade III and IV burns.
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