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At least 19 recordsLinked to original sources
PubMed1993

[Keratoplasty with 11-12 mm diameter for management of severely chemical-burned eyes].

Up to now 73 patients with 101 very severe eye burns have been operated on in our clinic. Thirty-nine patients were treated by a penetrating keratoplasty. More than 1 year after the accident 8 patients were treated with keratoplasties, 11-12 mm in diameter. These large diameters were necessary, because 6 patients developed widespread progressive corneal ulcerations, and in 2 patients the artificial epithelium failed to protect the denuded corneal stroma and sloughed off because of deep stromal defects. The long-term follow-up in these cases is now at least 1 year. Six grafts remained clear with a healthy epithelial layer. The resulting visual acuity in these cases ranged from 0.1 to 0.5. Five patients developed a cataract secondary to the application of steroids. Two grafts were rejected in a very early period 2-3 months after transplantation. In corneal melting processes including the limbal region, treatment with large keratoplasties seems to be a possibility for long-lasting healing and rehabilitation in very severe eye burns. Important for the prognosis of the graft obviously is the restoration of an intact limbal region.

Adolescent↗
PubMed1995

[Tenon-plasty and early keratoplasty in severe chemical eye burns].

In severe eye burns with destruction of extensive areas of the conjunctiva and epibulbar tissue, Tenon plasty has proved to be successful. Because the epithelium fails to cover the denuded stroma, the corneal surface must be protected by an artificial epithelium. If necrolysis occurs, a tectonic keratoplasty must be performed early. The clinical courses of 12 patients with 14 very severely burned eyes are reported. In addition to Tenon plasty, early penetrating keratoplasies with large diameters 10-16 mm were performed up to 3 months after the accident. The follow-up time was between 6 and 34 months (mean 15.1 months). In five cases the Tenon tissue showed marked inflammation, and the keratoplasties developed large, persistent epithelial defects and had to be covered by conjunctiva. In the other cases it was possible to preserve a healthy epithelial layer by applying soft contact lenses. In 79% of the cases an endothelial graft rejection was observed. In about 50% the transplants were lost. Early keratoplasties are mainly for tectonic repair in severely burned eyes. Optical rehabilitation was achieved in only a few cases.

Adult↗
PubMed1999

[Prospective study of eye burns at the Fort de France University Hospital].

PURPOSE: We report the results of a three-years prospective study focusing on ocular alkali burns conducted in the University hospital of Fort de France (French West Indies). PATIENTS AND METHODS: This case record survey included all alkali burns evaluated by ophthalmologists in the emergency unit of the Fort de France hospital. All recruited patients were either called to identify the alkali (pH determined with a Prolab pH-meter) or underwent an anterior chamber puncture showing evidence of an aqueous humor pH above 8. The recorded data were: age, gender, cause of burn, in case of aggression the relation between the victim and the aggressor, initial clinical findings, Ropper Hall classification. The therapeutic protocol was initiated according to this classification. The course of the ocular burn was noted. Economical and medicolegal consequences were assessed from duration of off work time and from information provided by the public prosecutor respectively. RESULTS: Twenty-four patients who had 39 burned eyes were included. Most ocular burns (18) were caused by aggressions with Alcali (ammonia, pH = 12.8). Most victims were men accused of adultery. In the West Indies, Alcali is thought to have power to drive away evil spirits. Most victims were young men (mean age 42 years). Eight court suits have been filed and in 5 cases the judge dismissed the charge. In 13 eyes, the delay to the first ocular wash was 30 minutes and resulted in serious ocular burn (Ropper Hall class 3 or 4). After application of the therapeutic protocol, 6 of these eyes recovered in an average 55 days; 3 required limbal autograft, 2 were successful. Three of these severe burns were complicated by spontaneous perforation (1 eye), atrophy (1 eye), and leucoma (1 eye). One patient was lost to follow-up. All minor ocular burns (Ropper Hall class 1 and 2) healed within an average 12 days (range 3-38 days). CONCLUSION: Particular circumstances of ocular alkali burns in Martinique (French West Indies) have been indentified in this study which established the seriousness of these burns and their social and sometimes legal consequences. The importance of prevention is emphasized. It would seem that minor ocular alkali burns do not require a treatment duration longer than 15 days. Finally, the clinical data reported in this study show that a delay of several minutes is required for the development of severe ocular alkali burns.

Adult↗
PubMed1996

[Keratoplasty with scleral rim after the most severe chemical eye burns of the anterior eye segment].

BACKGROUND: Corneo-scleral ulcerations and perforations are severe complications after most severe eye burns. One possibility to handle this situation is a keratoplasty with a scleral rim. This retrospective study was carried out to show the outcome after total replacement of the cornea after most severe eye burns. PATIENTS: Between 1986 and 1991 we carried out 12 keratoplasties with a scleral rim in 9 most severely burnt eyes of 7 patients. In 9 cases this intervention was the first transplantation. In 3 eyes a re-keratoplasty had to be carried out. RESULTS: All eyes could be saved after this surgical intervention, although all but two transplants failed. In eight cases the transplant decompensated and/or was replaced by scar tissue. Two transplants remained clear. Visual acuity was light perception in five cases, intact light projection in two cases, 1/35 in one case because of cataract formation and 0.8 in another case at the end of the observation period. The reasons for graft failure were multifactorial. Epithelial problems were the reason for graft failure in eight cases. Two of these also showed shrinkage of the eye lids with incomplete lid closure. In six cases severe vascularisation with scar formation was observed. It is remarkable that immunoreactions occurred only in four cases. This may be due to the fact that all patients were treated systemically with cyclosporin A. In one case the transplant failed after extensive surgery of the anterior segment. CONCLUSION: Our results show that the keratoplasty with a scleral rim can save the eye in the difficult situation of corneo-scleral ulceration or perforation. Nevertheless a visual rehabilitation could not be achieved in seven of nine cases. But all eyes were in a satisfying condition for further smaller transplants to achieve better visual acuity.

Accidents, Home↗
PubMed1988

Clinical application of epiderm growth factor in patients with most severe eye burns.

20 eyes of 11 patients suffering from most severe eye burns of grade 4 or worse were treated in addition to various other drugs with epiderm growth factor (EGF) or placebo in a double-blind test. Among 10 eyes treated with EGF, 6 achieved complete regeneration of the corneal epithelium, and 1 additional case, of the conjunctival epithelium. Among the eyes receiving placebo, only 3 out of 10 healed; all of them were also treated with fibronectin. Although in these very difficult cases EGF could not be investigated as a single therapy, and various other undefined factors may have been effective, in the extended course of the disease the period of EGF treatment was marked by a significant better regeneration of the epithelium.

Burns, Chemical↗
PubMed1997

Video fluorescein angiography of the anterior eye segment in severe eye burns.

PURPOSE: Severe eye burns often result in extensive necrosis of the conjunctiva and episcleral tissue. Video fluorescein angiography was performed to reveal the perfusion of the anterior eye segment after severe eye burns. METHODS: A scanning laser ophthalmoscope was used for anterior segment fluorescein angiography in 12 patients (14 eyes) with severe burns grade III-IV and in 7 healthy volunteers. RESULTS: Necrotic tissues occurred as non perfused areas and remained dark throughout the whole angiogram. In general, the borders from healthy to necrotic conjunctival tissue were sharply demarcated. Thus, the extent of scleral and limbal ischemia could be determined exactly. Injured vessels showed hyperfluorescence with late leakage. Damage of the subconjunctival tissue appeared as a deep weak fluorescence in the early angiography and exhibited patchy leakage in the late angiogram. CONCLUSIONS: Anterior segment angiography provides a basis for deciding the extent of surgical debridement of necrotic tissue in the acute phase of the burn. The determination of the extent of limbal and scleral ischemia may give useful information for early plastic-reconstructive procedures.

Adult↗
PubMed2002

Emergency treatment of chemical and thermal eye burns.

Chemical and thermal eye burns account for a small but significant fraction of ocular trauma. The speed at which initial irrigation of the eye begins, has the greatest influence on the prognosis and outcome of eye burns. Water is commonly recommended as an irrigation fluid. However, water is hypotonic to the corneal stroma. The osmolarity gradient causes an increased water influx into the cornea and the invasion of the corrosive substance into deeper corneal structures. We therefore recommend higher osmolarities for the initial rinsing to mobilize water and the dissolved corrosives out of the burnt tissue. Universal systems such as amphoteric solutions, which have an unspecific binding with bases and acids, provide a convenient solution for emergency neutralisation. Both conservative anti-inflammatory therapy and early surgical intervention are important to reduce the inflammatory response of the burnt tissue. In most severe eye burns, tenonplasty re-establishes the conjunctival surface and limbal vascularity and prevents anterior segment necrosis.

Burns, Chemical↗
PubMed1996

[Consensual inflammatory reaction in chemical eye burn of the rabbit eye].

BACKGROUND: Consensual ocular response has been known to occur following intracranial stimulation of the trigeminal nerve, intracameral injection of prostaglandins and other substances, after paracentesis and contusio bulbi. MATERIAL AND METHOD: We have examined the prostacyclin formation in both eyes after experimental alcali burn (0.25 mo/l NaOH) on 30 rabbits with ELISA over a follow up period of 14 days. RESULTS: After the alcali burn the aqueous prostacyclin level on the right eye is increased from 327 pg/ml aqueous to 27098 pg/ml aqueous, but on the left it stays normally. In conjunctiva and anterior uvea we measured normal amounts of prostacyclin. CONCLUSIONS: We could not find a consensual increase in prostacyclin formation in the anterior part of the fellow eye following alcali burn.

Animals↗
PubMed1997

Tenonplasty: a new surgical approach for the treatment of severe eye burns.

BACKGROUND AND OBJECTIVE: In the acute stage of most severe eye burns, the primary goal is survival of the globe. Initial tissue destruction may lead to extensive necrosis of the conjunctiva and underlying tissue down to the fornices, with resulting ischemia. These circumstances may cause a polymorphonuclear cell response, with resulting corneo-scleral ulceration and early melting of the globe. To reestablish the ocular surface, Tenonplasty was performed as a plastic procedure to reconstruct the conjunctival matrix of the globe up to the limbus. PATIENTS AND METHODS: Vital Tenon's sheets from the orbital region were prepared and advanced up to the limbus to cover the ischemic or ulcerating sclera with healthy, vascularized tissue. Fifty-nine patients with 75 severely burned eyes were treated with this procedure between 1987 and 1994. A total of 243 Tenon's flaps were prepared. RESULTS: In all cases, scleral ulcerations were prevented or healed. Epithelialization of the advanced Tenon's sheets was complete within 21 days in 80% of the cases and in all eyes within 54 days. Primary epithelialization of the burned cornea was achieved in approximately 31% of the cases. Fornices were sufficiently deep in about 74%, but severe symblepharon formation occurred in 26% of the cases. CONCLUSION: Tenonplasty may be an alternative surgical procedure to transplantation of autologous conjunctival or mucous grafts in restoring the conjunctival surface of the globe in severely burned eyes.

Adolescent↗
PubMed1990

[The nature and results of the treatment of eye burns based on data from the Chernovtsy Province Eye Trauma Center].

The character and results of eye burn treatment have been studied in 226 patients (307 eyes) aged from 10 to 80 years. The analysis of the character of eye burns has shown that the overwhelming majority of them were chemical ones (80.54%), of them 50% being alkaline. As to degree of severity, burns of moderate degree predominated (58.74%). The greatest part of the sufferers had everyday-life burns (67.7%). Results of treatment depended, mainly, on the severity of the burn. By the results of treatment, the patients were divided into 4 groups: group I included patients with total restoration of corneal transparency, who can return to their former labor activity; group-II patients with partially lost visual functions on account of remained, moderately expressed cicatricial opacifications of the cornea, who in future require repeated courses of resolving therapy; group-III patients with a remarkable loss of visual functions on account of coarse cicatricial opacifications of the cornea, who in future require surgical treatment--keratoplasty, keratoprosthesing and other surgical interventions; group IV-patients with total restoration of corneal transparency after treatment, but with insufficiently high visual acuity because of associated changes in the optic media and the eye fundus (beginning cataract, macular dystrophy, etc.), who require dispensary observation and treatment of associated diseases.

Accidents, Home↗
PubMed2001

[Glaucoma after extremely severe chemical and thermal eye burns. Surgical possibilities].

BACKGROUND: Late secondary glaucomas after severe chemical or thermal eye burns are associated with diagnostic and surgical difficulties. Routine filtering surgery (trabeculectomy) has a low success rate. In these eyes aqueous shunt implantation and cyclophotocoagulation are alternative procedures. PATIENTS: In our retrospective study, the records of 12 patients with 14 severe eye burns (grade IV) were analyzed. Nine eyes were treated with an aqueous shunt device (six von Denffer and three Ahmed implants). Diode laser cyclophotocoagulation (Iris Medical Instruments) was performed in five eyes. The mean time interval between surgery and accident was 88.3 months (aqueous shunt) and 32.8 months (cyclophotocoagulation). RESULTS: The mean follow-up was 45 +/- 36 months (von Denffer implant), 38 +/- 5 months (Ahmed implant), and 11 +/- 8 months (cyclophotocoagulation). Intraocular pressure (IOP) was reduced from 39 +/- 7 to 23 +/- 6 (von Denffer implants) and from 38 +/- 3 to 8 +/- 10 (Ahmed implants). Mean IOP before treatment with cyclophotocoagulation was 33 +/- 8 and 18 +/- 2 after treatment. Systemic carbonic anhydrase inhibitors were stopped in all patients. Visual acuity deteriorated in five of nine eyes treated with aqueous shunt devices and was unchanged or better in all eyes treated with cyclophotocoagulation. Multiple re-operations were necessary after aqueous shunt implantation. Severe complications leading to failure in these eyes were encapsulated bleb in four eyes, expulsive hemorrhage in one eye, and phthisis in one eye. Cyclophotocoagulation was repeated in two eyes. Severe complications were not observed. CONCLUSION: IOP reduction was effective and comparable in both procedures. Because of the high incidence of severe complications after shunt surgery, we prefer cyclophotocoagulation for the treatment of intractable glaucoma after severe eye burns.

Adult↗
PubMed1993

[Chemical and thermal eye burns in the residential area of RWTH Aachen. Analysis of accidents in 1 year using a new automated documentation of findings].

BACKGROUND: Until now there were no statistical data on the incidence and the prevalence of eye burns. Therefore we studied all patients coming to our hospital from the area of Aachen with eye burns during the time from September 1990 until August 1991. PATIENTS AND METHODS: All patients underwent a standardized examination including special history of the burning agent, industrial medical aspects and the employers liability insurance association. The documentation of the anterior eye segment pathology was scored separately for each eye encoded by location and special items. This documentation was worked up by the aid of a database (Filemaker II). 171 patients with eye burns were documented during one year. 65 patients had both eyes burned resulting in 236 documented records. RESULTS: The 171 accidents can be divided in 104 (61%) industrial accidents and 64 (37%) housework accidents. 3 accidents were of unknown origin. Classification of burns was scored according to Reim 1991. 208 (88%) eyes showed score I burns, 27 (11.5%) score II and only one patient showed a score III eye burn. We saw 121 (70%) male patients, 39 (23%) female patients and 11 children (7%). The main age group ranged from 16-45 years. 28% (n = 30) of all accidents happened in machine factories, which have thereby in our study the highest incidence of industrial accidents. CONCLUSION: By means of a one-year statistic we found that over 60% of all eye burns were industrial accidents, 28 in machine factories and 20% in service industries. 37% houseworks accidents are very difficult to prevent because of a deficit of safety rules.

Accidents, Home↗
PubMed2000

Eye burns: an emergency and continuing problem.

Adequate treatment of eye burns is an essential task of rescue teams. Clinical and occupational medicine studies have shown that efficient emergency treatment can prevent severe eye damage, but therapy is frequently delayed or inadequate. When initial therapy has been delayed or missed, several treatment strategies, including surgery, are available that may improve the outcome of an injury with poor visual prognosis. Discussed in this review are common accident mechanisms, causative agents and biophysical/pathogenetic aspects of eye burns, together with emergency and long-term treatment strategies including surgical procedures, and factors influencing outcome.

Antidotes↗
PubMed1998

Retinal cytokine response in mouse alkali-burned eye.

The kinetics of inflammatory cytokines in sensory retina of mice with corneal alkali-burned eyes were examined. Retinal samples were collected from ICR mice with unburned and alkali-burned eyes from day 3 to day 14. Enzyme-linked immunosorbent assay was used to quantitate the expression levels of interleukin-1 alpha (IL-1 alpha), IL-1 beta and IL-6. Concentrations of IL-1 beta and IL-6 were significantly elevated at day 3 after alkali burn, and reduced to normal level by day 7. The concentration of IL-1 alpha was below assay sensitivity at all times. A significant elevation of IL-1 beta and IL-6 in the sensory retina may contribute to the retinal inflammatory response in the alkali-burned eyes. This is the first report suggesting that the retina is involved in the damage process of alkali burn.

Animals↗
PubMedDate not supplied

[Expert assessment of initial surgical management after experimental chemical eye burn].

BACKGROUND: Initial surgical treatment of severe eye burns is important for the long lasting healing period. To look closer at the efficacy of the early surgical treatment and the possible consequences for woundhealing, the surgical interventions were examined in an animal experiment. MATERIALS AND METHODS: The right eye of 20 rabbits each was burned with 1 n NaOH for 30 seconds followed by a surgical treatment 48 hours later. In the first study necrosectomy, tenonplasty, application of an artificial epithelium and blepharoplasty was withdrawn and the fornices were prevented from cicatrization by mechanical treatment treatment with blunt spatula. Antiinflammatory depotinjection of Volon A 40 was applicated additionally. After an interval of 4-18 weeks the eyes were examined histologically. RESULTS: A higher risk for infections could be observed in eyes which underwent blepharorhaphy. Furthermore proliferative processes and corneal ulcerations were predominant. In contrast to these findings the latter complications could be prevented due to the clinical inspection of the artificial epithelium and described mechanical irritation of the fornices in the second study. DISCUSSION: It could be shown that proliferative processes are major complications after severe burns of the eye. Nevertheless the intensity could be minimized by the consequent therapy. Furthermore it could be demonstrated that the artificial epithelium is an effective tool providing good prognosis for subsequently planned keratoplasty. To enable necessary postoperative inspection blepharoplasty should be avoided.

Animals↗
PubMed2001

[Long-term results of large diameter keratoplasties in the treatment of severe chemical and thermal eye burns].

BACKGROUND: In severe chemical and thermal eye burns the limbal stem cells, which are important for the regeneration of the corneal epithelium, are lost. In our retrospective study two questions were investigated: 1) is it possible to restore the limbal region by transplantation of large diameter keratoplasties 2) has the time of transplantation an influence on the clinical outcome. PATIENTS AND METHOD: In a retrospective study the outcome of 48 eyes (43 patients) with severe chemical and thermal burns were analysed. Large diameter (11 - 12 mm) penetrating keratoplasties were performed between 1987 and 1996. Complete limbal deficiency was present in 17 eyes, while 31 eyes had developed sterile corneal ulceration. According to the time of transplantation three different groups were distinguished. Group I (early keratoplasty, n=24): transplantation within 3 months after the accident (mean: 26 days). Group II (intermediate keratoplasty, n=13): transplantation between 4 - 18 months after the burn (mean: 190 days). Group III (late keratoplasty, n=11): surgery more than 18 months after the injury (mean: 36.6 months). RESULTS: Follow-up time was 28.4 months in early keratoplasty, 26.4 months after intermediate keratoplasty, and 34.3 months in late keratoplasty. Long-term results of the keratoplasties were poor. 60.4 % of the transplants failed due to surface problems, 18.8 % due to endothelial rejection episodes. Late keratoplasties were significantly more successful than intermediate keratoplasties. 25 % of the early keratoplasties and 36.4 % of the late keratoplasties showed an intact limbal region at the end of the follow-up time, but none of intermediate keratoplasties. CONCLUSION: The prognosis for large diameter keratoplasties depends on the time of transplantation. Late and early keratoplasties had the best results. However, survival of heterologous stem cells is limited.

Adolescent↗
PubMed2001

Phosphate buffer in alkali eye burns as an inducer of experimental corneal calcification.

Corneal calcification is a common problem in severe inflammation, chronic glaucoma, renal disorders and other diseases with disturbed calcium and phosphorus metabolism. The pathogenesis of corneal calcifications in ocular diseases is not yet completely understood. We present a model of an induced corneal calcification by local treatment. In a double-masked experiment 16 rabbits underwent eye burn of one cornea followed by immediate rinsing (160 ml) with isotonic phosphate buffer (n=8) or saline solution (n=8) three time a day for 16 days. Tissues were excised, shock frozen and cut into 10 microm slices, freeze dried and coated with evaporated carbon. In the phosphate buffer group an early onset of corneal opacification occurred resulting in completely white corneas after 16 days, combined with corneoscleral ulceration. The other group showed similar corneal erosion and a little corneal ulceration, but no opacifications. The opacifications of the phosphate buffer group could be identified as calcifications by direct measurements of calcium and phosphate (by energy dispersive X-ray analysis on corneal samples). In conclusion, inappropriate application of phosphate leads to uncontrolled calcifications of the cornea after severe burns to the eye. This reflects clinically observed calcifications after eye burns and possibly the adverse side effects of phosphate buffered eye drops being applied in ophthalmology.

Alkalies↗