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AimTo compare the predictive outcome of ocular burns using two different prognostic classification systems, that is, Dua and Roper Hall classification.Patients and methodsIn a prospective, randomised, controlled clinical trial, the extent of acute ocular burns in 100 patients was graded by Roper Hall and Dua classifications. Patients were randomised in two groups of 50 each to receive conventional medical therapy alone or additional amniotic membrane transplantation (AMT). Moderate burns were graded similarly (grade II and III) under both systems, while severe burns were classified differently and compared further. Baseline parameters (size of epithelial defect, corneal haze, limbal ischaemia, conjunctival involvement and visual acuity) and outcome variables (healing of epithelial defect, corneal clarity, corneal vascularisation, visual outcome and symblepharon) after 1 year were noted and compared.ResultsThere was no difference in terms of time taken and rate of healing of epithelial defect, but there was a significant difference in extent of corneal vascularisation between grades IV, V and VI (p<0.05). In patients who received AMT in addition to medical therapy, the degree of corneal clarity achieved was significantly better in patients with grade IV burns than either grade V (p=0.045) or grade VI (p=0.024) burns, and final visual acuity was significantly better in these patients (p=0.043). On comparison of patients with grade IV burns (with and without AMT), the outcome in terms of extent of corneal vascularisation was significantly better (p=0.0124) in patients who received AMT.ConclusionsDua classification by providing further subclassification of grade IV ocular burns by Roper Hall into three separate grades has a superior prognostic predictive value in severe ocular burns.

AimsTo evaluate the role of amniotic membrane transplantation in patients with acute ocular burns.MethodsIn a prospective, randomised, controlled clinical trial, 100 patients with grade II to IV acute ocular burns (Roper Hall Classification) were recruited. 50 patients with grade II–III burns were graded as moderate burns, and 50 patients with grade IV burns were graded as severe burns. Both groups were individually randomised into control group (n=25) and study group (n=25). The corresponding grade of ocular surface burn by Dua classification was noted. The eyes in the study group underwent amniotic membrane transplantation in addition to conventional medical therapy. In the control group, conventional medical therapy along with mechanical release of early adhesions as and when necessary was instituted. Rate of healing of corneal epithelial defect, visual acuity, extent of corneal vascularisation, corneal clarity and formation of symblepharon were compared in both groups.ResultsIn patients with moderate ocular burns treated with amniotic membrane transplantation, the rate of epithelial healing was significantly better than the group treated with standard medical therapy alone (p=0.0004). There was no overall difference in the final visual outcome, symblepharon formation, corneal clarity and vascularisation with or without amniotic membrane transplantation.ConclusionsAmniotic membrane transplantation in eyes with acute ocular burns promotes faster healing of epithelial defect in patients with moderate grade burns. There seems to be no definite long-term advantage of amniotic membrane transplantation over medical therapy and mechanical release of adhesions in terms of final visual outcome, appearance of symblepharon and corneal vascularisation when compared in a controlled clinical setting.

Red eye is the cardinal sign of ocular inflammation. The condition is usually benign and can be managed by primary care physicians. Conjunctivitis is the most common cause of red eye. Other common causes include blepharitis, corneal abrasion, foreign body, subconjunctival hemorrhage, keratitis, iritis, glaucoma, chemical burn, and scleritis. Signs and symptoms of red eye include eye discharge, redness, pain, photophobia, itching, and visual changes. Generally, viral and bacterial conjunctivitis are self-limiting conditions, and serious complications are rare. Because there is no specific diagnostic test to differentiate viral from bacterial conjunctivitis, most cases are treated using broad-spectrum antibiotics. Allergies or irritants also may cause conjunctivitis. The cause of red eye can be diagnosed through a detailed patient history and careful eye examination, and treatment is based on the underlying etiology. Recognizing the need for emergent referral to an ophthalmologist is key in the primary care management of red eye. Referral is necessary when severe pain is not relieved with topical anesthetics; topical steroids are needed; or the patient has vision loss, copious purulent discharge, corneal involvement, traumatic eye injury, recent ocular surgery, distorted pupil, herpes infection, or recurrent infections.

Corneal damage may become permanent if the supply of limbal stem cells is compromised. In this long-term follow-up study of 113 eyes treated with autologous transplantation of limbal stem-cell cultures, a transparent, renewing corneal epithelium was restored in 77% of eyes and remained stable over time. Corneal damage may become permanent if the supply of limbal stem cells is compromised. In this long-term follow-up study of 113 eyes treated with autologous transplantation of limbal stem-cell cultures, a transparent, renewing corneal epithelium was restored in 77% of eyes and remained stable over time. A clear cornea is essential to visual acuity and depends on stromal avascularity and epithelial integrity. 1 Corneal renewal and repair are mediated by stem cells of the limbus, the narrow zone between the cornea and the bulbar conjunctiva. 2 Ocular burns may destroy the limbus, causing limbal stem-cell deficiency. In such cases, the cornea acquires an epithelium through the invasion of bulbar conjunctival cells. This process leads to neovascularization, chronic inflammation, and stromal scarring, with corneal opacity and loss of vision. 3 Allogeneic corneal transplantation (keratoplasty) restores transparency temporarily, but eventually, the conjunctival cells begin to invade and resurface the cornea. The . . .

Corneal alkali burns are severe ocular injuries characterized by extensive tissue damage, inflammation, oxidative stress, and neovascularization, which often lead to long-term visual impairment and corneal fibrosis. This review comprehensively examines the mechanisms underlying alkali burn injuries, including the roles of inflammatory mediators, oxidative stress, and cellular responses, while highlighting current and emerging therapeutic approaches. Traditional treatments, such as corticosteroids and surgical interventions, often have limited efficacy and significant side effects. Recent advances in innovative therapies, including stem cell-derived exosomes, hydrogel-based drug delivery systems, and herbal components, demonstrate significant potential for improving corneal healing and reducing complications. These novel approaches aim to mitigate inflammation, enhance epithelial repair, and prevent neovascularization, offering promising pathways for scar-free healing and the restoration of corneal transparency. Future research should focus on integrating these therapies into multifunctional treatment strategies to optimize clinical outcomes and improve quality of life for patients suffering from corneal alkali burns.

Corneal alkali burns can cause persistent inflammation and corneal neovascularization. In this study, we divided corneal alkali burned rabbits into the untreated group, the blank lens group, the radiation-treated umbilical cord mesenchymal stem cells (UCMSC) lens group, and the UCMSC I.V. group, and then measured corneal inflammation, neovascularization and corneal injury repair via slit lamp microscopy, captured anterior segment optical coherence tomography (AS-OCT), and performed hematoxylin-eosin staining. Compared with those in the other experimental groups, radiation-treated UCMSC lenses significantly decreased inflammatory index (IF) scores, areas of corneal blood vessels and corneal epithelial injury. The expression of interleukin (IL)-17 in corneas treated with radiation-treated UCMSC lenses was lower than that in corneas treated with blank lenses, and radiation-treated UCMSC lenses exhibited greater expression of IL-4 and signal transducer and activator of transcription 1 (STAT1), while the expression of cluster of differentiation-3G (CD3G), a linker for the activation of T cells (LAT), IL-6, IL-1B, CC chemokine receptor 6 (CCR6) and IL-23 exhibited the opposite effects (all P  < 0.05). Our findings demonstrated that irradiated UCMSC-coated high oxygen-permeable hydrogel lenses on the ocular surface inhibited corneal angiogenesis and inflammation after corneal alkaline burns. The downregulation of Th17 cell differentiation might be responsible for these effects.

Corneal alkali burns persist as a significant challenge in our field, often leading to a prolonged treatment course with various sight-threatening problems. This work, of utmost importance, aimed to apply the photo-tissue bonding technique (PTB) to weld the amniotic membrane (AM) to the corneal surface versus an amniotic membrane graft (AMG) and explore its safety in saving corneal protein against alkali burn. Methods Twenty-seven rabbits with an induced corneal ulcer using 1 mol/L NaOH solution. Nine rabbits were used as an ulcer group without treatment, and the rest (n = 18) were subjected to two treatment protocols with AM. The first was attaching the AM to the corneal ulcer through photo-tissue bonding using 532 nm and rose Bengal stain as a photosynthesizing agent. The second was using cyanoacrylate glue as a tissue adhesive. The corneal total protein (TP), refractive index (RI), DNA fragmentation, and oxidative stress index (OSI) were evaluated. Results: The cornea’s TP showed a significant decrease (p˂0.001) immediately, 1 week, and 2 weeks after ulcer induction (-58.9%, -64.4%, and − 72.6%, respectively). The treatment with AM PTB showed improvement immediately (-45.2%, p˂0.001), after one week (-27.4%, p˂0.01), and after two weeks (-14.38%, p˂0.05). Moreover, the treatment with AMG showed improvement after the same periods with percentage changes of -52.05%, (p˂0.001), -41.8% (p˂0.001), and − 32.2%, (p˂0.01) with respect to the control. Moreover, RI of corneal protein showed improvement after two weeks of treatment with AM PTB (3%, p˃0.05) and AMG (7%, p˃0.05), respectively. The corneal protein DNA base pairs improved 88.49% for AM PTB and 82.35% for the AMG group. The oxidative stress was shifted towards an antioxidative state in AM PTB (-3.9%, P > 0.05) and the AMG group (15.9%, P < 0.05). Conclusion: The AM PTB technique used in corneal ulcers showed promising improvement in total corneal proteins, refractive index, DNA fragmentation, and OSI than AMG using cyanoacrylate glue. These results strongly support the use of AM PTB for ophthalmic purposes, suggesting its potential to enhance clinical research and practice for patients with corneal ulcers and ocular surface diseases.

Corneal chemical burns can lead to blindness following serious complications. As most of these complications are caused by failure of reepithelization during the acute phase, treatment at this stage is critical. Although there have been some studies on corneal injury recovery using adipose tissue-derived stem cells (ADSCs), none has reported the effect of topical cell-free conditioned culture media (CM) derived from ADSCs on corneal epithelial regeneration. Here, the best conditions for CM were selected and used for in vitro and in vivo experiments. Corneal burn in rats was induced using 100% alcohol. The chosen CM was administered to corneal burn rats (CM-treated [CT] group) four times a day for three days and this group was compared with the normal control and corneal burn (CB) groups. Biomicroscopic fluorescence images and the actual physical corneas were taken over time and used for analysis. mRNA levels of hepatocyte growth factor and epidermal growth factor (EGF) were significantly increased, whereas those of vascular endothelial growth factor, interleukin (IL)-1β, IL-6, IL-10, and matrix metalloproteinase-9 were significantly decreased in the CT group compared with those in the CB group. The numbers of proliferating cell nuclear antigen- and zonular occludens-1-positive cells in the CT group were significantly higher than those in the CB group. The macrophage-infiltrating corneas in the CT group expressed significantly more of the M2 marker arginase than corneas in the CB group. Optimal CM (× 0.5 concentration) treatment significantly accelerated the migration of corneal epithelial cells and induced upregulation of the expression of IL-6, EGF, and C-X-C chemokine receptor type 4 mRNAs. Overall, in this study, topical administration of cell-free CM promoted regeneration of the corneal epithelium after induction of chemical burns.

Purpose Characterize ocular trauma and visual outcomes from firework injuries at a level I trauma center. Methods Retrospective review of all firework injuries at Harborview Medical Center between 2003 and 2013. Results Three hundred and twenty-seven patients sustained firework injuries, of which 100 (31%) sustained ocular injuries. The average age of all patients who sustained fireworks injuries was 24.2 years, 89% were male and 54% of injuries occurred within 48 h of 4 July. Ocular injuries were most commonly caused by mortars (24%) and rockets (22%). Rockets were associated with four times the frequency of ocular injuries as compared with non-ocular injuries ( P <0.001). Spectators were more likely to sustain ocular injuries than non-ocular injuries ( P =0.001). The most common injuries sustained were corneal abrasions (67%), hyphemas (42%), eyelid injuries (39%), and ruptured globes (17%). Twenty-eight percent of patients with ocular injuries required surgical intervention. Ruptured globes occurred in 17% of patients, with the majority being complex corneoscleral lacerations. Fifty-eight percent of patients who sustained ruptured globes were left with no light perception in the affected eye. Average follow-up was 188 days. Average visual acuity significantly improved from logMAR 1.8±1.6 at presentation to logMAR 1.3±1.8 at last follow-up. Conclusions Firework-related ocular trauma frequently results in vision-threatening pathology. Prompt referral to and treatment by ophthalmologists is critical. This study documents the dangers inherent in the personal use of fireworks and provides data that may help guide public policy to decrease the frequency of these devastating injuries.