Randomised Control Trial Comparing the Effectiveness of Methylcellusose Eye Dressings (Geliperm) and Ocular Lubricants in the Prevention of Exposure Keratopathy in the Critically Ill

Abstract

Abstract: : Purpose: . Microbial keratitis, particularly pseudomonas, has been reported among critically ill patients and the need for effective eye care in ICU (Intensive Care Unit) has been recognised for some time. However, there is no clear consensus defining the best form of eye care. A recent survey in the UK found that 75% of ICUs used Geliperm routinely as eye care, with 25% using ocular lubricants such as Lacrilube or Lubritears. Although Geliperm is the most widely used eye care measure on ICU, its efficacy has never previously been adequately assessed. Geliperm was originally designed as a wound dressing and there is no evidence to support its use in eye protection. This randomised control trial attempts to provide direction regarding the best practice for ICU eye care. Methods: This study was conducted in accordance with the Declaration of Helsinki and was approved by the East London and the City Regional Research Ethics Committee. All patients admitted to the ICU at the Royal London Hospital were considered for inclusion. Exclusion criteria included primary orbital injury, or length of stay likely to be less than 48 hours. Each patient had each of their eyes randomly assigned to either Geliperm or Lacrilube such that each patient received both treatments concurrently in different eyes. Independent randomisation sequencing and statistical support was provided by the Wolfson Centre for preventative disease, University of London. An ophthalmologist examined all eyes of patients using a portable slitlamp. record was made of grade of exposure keratopathy, chemosis, palpebral aperture, sedation score, length of stay on ITU, APACHE disability score and reason for admission. Results: At the time of submission 30 patients have been recruited to the study. This is the midpoint of the sample size projection and our data thus far show no significant difference between the efficacies of the two treatments in all grades of exposure keratopathy (p>0.05). No significant variance in palpebral aperture or conjunctival chemosis was noted between groups. Nor was significant variance detected in general health indicators such as sedation scores or APACHE scores. Conclusions: Our preliminary data suggest that both treatments are equally effective. We project that we shall have the full results of our study in 3 months and will present them in their entirety.

Keywords: cornea: epithelium • keratitis • clinical (human) or epidemiologic studies: treatment/prevention assessment/controlled