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Rasik B Vajpayee - One of the best experts on this subject based on the ideXlab platform.
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treatment of acute ocular Chemical Burns
Survey of Ophthalmology, 2017Co-Authors: Namrata Sharma, Tushar Agarwal, Manpreet Kaur, Virender S Sangwan, Rasik B VajpayeeAbstract:Ocular Chemical Burns are an ophthalmic emergency and are responsible for 11.5%-22.1% of ocular injuries. Immediate copious irrigation is universally recommended in acute ocular Burns to remove the offending agent and minimize damage. Conventional medical therapy consists of the use of agents that promote epithelialization, minimize inflammation, and prevent cicatricial complications. Biological fluids such as autologous serum, umbilical cord blood serum, platelet-rich plasma, and amniotic membrane suspension are a rich source of growth factors and promote healing when used as adjuncts to conventional therapy. Surgical treatment of acute ocular Burns includes the debridement of the necrotic tissue, application of tissue adhesives, tenoplasty, and tectonic keratoplasty. Amniotic membrane transplantation is a novel surgical treatment that is increasingly being used as an adjunct to conventional treatment to promote epithelial healing, minimize pain, and restore visual acuity. Various experimental treatments that aim to promote wound healing and minimize inflammation are being evaluated such as human mesenchymal and adipose stem cells, beta-1,3 glucan, angiotensin-converting enzyme inhibitors, cultivated fibroblasts, zinc desferrioxamine, antifibrinolytic agents, antioxidants, collagen cross-linking, and inhibitors of corneal neovascularization.
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comparison of amniotic membrane transplantation and umbilical cord serum in acute ocular Chemical Burns a randomized controlled trial
American Journal of Ophthalmology, 2016Co-Authors: Namrata Sharma, Thirumurthy Velpandian, Divya Singh, Prafulla K Maharana, Alka Kriplani, Ravindra Mohan Pandey, Rasik B VajpayeeAbstract:Purpose To compare the efficacy of topical umbilical cord serum drops (UCS) and amniotic membrane transplantation (AMT) in acute ocular Chemical Burns. Design Randomized controlled trial. Methods setting: Tertiary care hospital. study population: Forty-five eyes with acute Chemical Burns of grade III, IV, and V (Dua's classification) presenting within the first week of injury were randomized into 3 groups (15 each). Patients with perforation/impending corneal perforation were excluded from the study. intervention: Groups 1, 2, and 3 received UCS with medical therapy (MT), AMT with MT, and MT alone, respectively. main outcome measure: Time to complete epithelialization. Results The mean time to complete epithelialization was 56.7 ± 14.9, 22.0 ± 10.2, and 22.9 ± 10.1 days in MT, AMT, and UCS groups, respectively, with a significant difference between MT and AMT ( P = .001) and between MT and UCS ( P = .001), but not between UCS and AMT ( P = .9). Improvement in pain score was better with UCS than AMT ( P value: .012, .002, and .012 on days 7, 14, and 21, respectively). Corneal clarity was better in the UCS group at 21 ( P = .008) and 30 days ( P = .002), but not at 3 months ( P = .9). By month 3, visual outcome, symblepharon, tear film status, and lid abnormalities were comparable between the 3 groups. Conclusions UCS and AMT, as an adjuvant to standard medical therapy in acute Chemical injury, are equally efficacious. UCS has the advantage of faster improvement in corneal clarity, better pain control, and avoidance of surgery in an inflamed eye.
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comparison of umbilical cord serum and amniotic membrane transplantation in acute ocular Chemical Burns
British Journal of Ophthalmology, 2015Co-Authors: Namrata Sharma, Shiv Shankar Lathi, Sri Vatsa Sehra, Tushar Agarwal, Rajesh Sinha, Jeewan S Titiyal, Thirumurthy Velpandian, Radhika Tandon, Rasik B VajpayeeAbstract:Purpose To compare the efficacy of umbilical cord serum (UCS) with amniotic membrane transplantation (AMT) in cases of acute ocular Chemical Burns. Methods In a retrospective, interventional, comparative case series, 55 eyes with grades III, IV and V Chemical Burns (Dua9s classification) who presented within 3 weeks of injury were evaluated. Patients were treated with conventional medical (CM group, 20 eyes) management alone or combined with either UCS (UCS group, 17 eyes) or AMT (AMT group, 18 eyes). The parameters evaluated were time to epithelialisation, epithelial defect diameter, epithelial defect area, corneal clarity, tear break-up time (TBUT), Schirmer test and best-corrected vision. Results UCS and AMT groups showed early epithelialisation as compared with the CM group (Kaplan–Meier analysis=0.01). Mean time for healing of epithelial defect was 57.7±29.3, 27.4±19.0, 41.1±28.9 days in the CM, UCS and AMT groups, respectively (p=0.02). Mean TBUT at the last follow-up was 8.6±0.7, 10.3±1.1, 9.4±1.2 s in the CM, UCS and AMT groups, respectively (p=0.02). The mean Schirmer value at the last follow-up was 13.7±1.0, 16.9±3.0 and 13.2±1.5 mm in the CM, UCS and AMT groups, respectively (p=0.01). The visual outcomes and the occurrence of corneal vascularisation, symblepheron, ectropion and entropion were comparable in between the groups. Conclusions Our study suggests that the UCS therapy may be a better alternative to AMT in acute moderate to severe (grades III, IV and V) ocular Chemical Burns, as it avoids surgical manoeuvre in already inflamed eyes.
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evaluation of umbilical cord serum therapy in acute ocular Chemical Burns
Investigative Ophthalmology & Visual Science, 2011Co-Authors: Namrata Sharma, Jeewan S Titiyal, Thirumurthy Velpandian, Radhika Tandon, Rasik B Vajpayee, Manik GoelAbstract:PURPOSE To evaluate the role of umbilical cord serum therapy in cases of acute ocular Chemical Burns. METHODS In a double-blind prospective randomized controlled clinical study, 33 eyes of 32 patients with acute ocular Chemical Burns of grade III, IV, and V severity were randomized into three groups: umbilical cord serum (n = 12), autologous serum (n = 11), and artificial tears (0.5% HPMC+0.3% glycerin; n = 10). In addition, all eyes received standard medical therapy. The parameters evaluated were pain score, size, and area of epithelial defect, extent of limbal ischemia, corneal clarity, and symblepharon formation. The patients were followed up at day 1, 3, 7, 14, and 21 and at the end of months 1, 2, and 3. RESULTS Mean time to complete epithelialization was 21.16 ± 26.81, 56.6 ± 35.5, and 40.13 ± 35.79 days in cord serum, autologous serum, and artificial tears groups respectively (P = 0.02). By day 21, the mean percentage decrease in epithelial defect diameter was 94.63 ± 11.99 with cord serum compared with 53.17 ± 34.81 and 64.22 ± 42.43 with autologous serum and artificial tears, respectively (P = 0.01). By month 3, the extent of limbal ischemia with cord serum showed a mean percentage decrease of 73.43 ± 25.51 compared with 35.64 ± 25.60 and 43.71 ± 28.71 with autologous serum and artificial tears, respectively (P = 0.008). More patients had clear corneas with cord serum compared with autologous serum and artificial tears (P = 0.048). No significant difference was seen between the groups with regard to symblepharon formation (P = 0.07). CONCLUSIONS Umbilical cord serum therapy is more effective than autologous serum eye drops or artificial tears in ocular surface restoration after acute Chemical injuries. (www.controlled-trials.com number, ISRCTN08131903.).
Chengjin Gao - One of the best experts on this subject based on the ideXlab platform.
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ten year epidemiological study of Chemical Burns in jinshan shanghai pr china
Burns, 2013Co-Authors: Chengjin GaoAbstract:Abstract Background The epidemiological pattern of Chemical Burns varies widely in different areas of the world. To analyse effective preventive approaches, an insight into the pattern of injury is desirable. However, our data are only limited to Shanghai area, China. Methods A 10-year retrospective review includes all patients with Chemical Burns admitted to the Department of Burn and Plastic Surgery from January 2001 to December 2010; those who were admitted to the ophthalmologic department or other departments were excluded. The data collected included age, gender, injury pattern, patient workplaces, aetiological agents, incidence by month and year, burn size, burn depth and site, time for immediate irrigation, length of hospital stay and outcome. Results A total of 615 patients admitted to our department for in-hospital treatment of Chemical burn injury were included in the study. The mean age was 32.1 ± 12.3 years with a range of 2–66 years. A total of 562 cases (91.4%) were male and 53 cases (8.6%) female. The mean total burn surface area (TBSA) was 30.3 ± 24.7% with a mean full-thickness burn area of 17.5 ± 23.8%. Most Chemical Burns took place in summer and fall. The majority of Chemical Burns were work related (93.0%); among them accidents that happened in private factories were predominant (70.8%). Although caustic soda was the leading cause of all Chemical Burns (15.8%), acid burn was the most common (45.2%). The extremities were the most frequent areas of injuries, followed by head and neck. Most cases had none (30.4%) or insufficient (61.1%) immediate irrigation after injury. In all patients, 47 cases had inhalation injuries, 94 cases accompanying ophthalmologic Burns, 51 cases accompanying other associated injuries and 67 cases Chemical toxicity. A total of 212 cases (34.5%) underwent early total or tangential excision and skin or skin flap grafting in the first week after injury. The mean length of hospital stay was 44.1 ± 24.7 days. Sixteen cases died of respiratory failure, sepsis or multiple organ dysfunction syndrome (MODS), giving a mortality rate of 2.6%. Conclusion Safety training, preventive measures and following safety rules and strict regulation are of paramount importance for workers to prevent and reduce Chemical Burns in Chemical enterprises, especially in private factories. Appropriate first-aid training that includes copious spot lavage should be emphasised. Eschar excision as early as possible and skin or skin flap grafting in deep wounds could reduce the possibility of poisoning and disability.
Namrata Sharma - One of the best experts on this subject based on the ideXlab platform.
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treatment of acute ocular Chemical Burns
Survey of Ophthalmology, 2017Co-Authors: Namrata Sharma, Tushar Agarwal, Manpreet Kaur, Virender S Sangwan, Rasik B VajpayeeAbstract:Ocular Chemical Burns are an ophthalmic emergency and are responsible for 11.5%-22.1% of ocular injuries. Immediate copious irrigation is universally recommended in acute ocular Burns to remove the offending agent and minimize damage. Conventional medical therapy consists of the use of agents that promote epithelialization, minimize inflammation, and prevent cicatricial complications. Biological fluids such as autologous serum, umbilical cord blood serum, platelet-rich plasma, and amniotic membrane suspension are a rich source of growth factors and promote healing when used as adjuncts to conventional therapy. Surgical treatment of acute ocular Burns includes the debridement of the necrotic tissue, application of tissue adhesives, tenoplasty, and tectonic keratoplasty. Amniotic membrane transplantation is a novel surgical treatment that is increasingly being used as an adjunct to conventional treatment to promote epithelial healing, minimize pain, and restore visual acuity. Various experimental treatments that aim to promote wound healing and minimize inflammation are being evaluated such as human mesenchymal and adipose stem cells, beta-1,3 glucan, angiotensin-converting enzyme inhibitors, cultivated fibroblasts, zinc desferrioxamine, antifibrinolytic agents, antioxidants, collagen cross-linking, and inhibitors of corneal neovascularization.
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comparison of amniotic membrane transplantation and umbilical cord serum in acute ocular Chemical Burns a randomized controlled trial
American Journal of Ophthalmology, 2016Co-Authors: Namrata Sharma, Thirumurthy Velpandian, Divya Singh, Prafulla K Maharana, Alka Kriplani, Ravindra Mohan Pandey, Rasik B VajpayeeAbstract:Purpose To compare the efficacy of topical umbilical cord serum drops (UCS) and amniotic membrane transplantation (AMT) in acute ocular Chemical Burns. Design Randomized controlled trial. Methods setting: Tertiary care hospital. study population: Forty-five eyes with acute Chemical Burns of grade III, IV, and V (Dua's classification) presenting within the first week of injury were randomized into 3 groups (15 each). Patients with perforation/impending corneal perforation were excluded from the study. intervention: Groups 1, 2, and 3 received UCS with medical therapy (MT), AMT with MT, and MT alone, respectively. main outcome measure: Time to complete epithelialization. Results The mean time to complete epithelialization was 56.7 ± 14.9, 22.0 ± 10.2, and 22.9 ± 10.1 days in MT, AMT, and UCS groups, respectively, with a significant difference between MT and AMT ( P = .001) and between MT and UCS ( P = .001), but not between UCS and AMT ( P = .9). Improvement in pain score was better with UCS than AMT ( P value: .012, .002, and .012 on days 7, 14, and 21, respectively). Corneal clarity was better in the UCS group at 21 ( P = .008) and 30 days ( P = .002), but not at 3 months ( P = .9). By month 3, visual outcome, symblepharon, tear film status, and lid abnormalities were comparable between the 3 groups. Conclusions UCS and AMT, as an adjuvant to standard medical therapy in acute Chemical injury, are equally efficacious. UCS has the advantage of faster improvement in corneal clarity, better pain control, and avoidance of surgery in an inflamed eye.
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comparison of umbilical cord serum and amniotic membrane transplantation in acute ocular Chemical Burns
British Journal of Ophthalmology, 2015Co-Authors: Namrata Sharma, Shiv Shankar Lathi, Sri Vatsa Sehra, Tushar Agarwal, Rajesh Sinha, Jeewan S Titiyal, Thirumurthy Velpandian, Radhika Tandon, Rasik B VajpayeeAbstract:Purpose To compare the efficacy of umbilical cord serum (UCS) with amniotic membrane transplantation (AMT) in cases of acute ocular Chemical Burns. Methods In a retrospective, interventional, comparative case series, 55 eyes with grades III, IV and V Chemical Burns (Dua9s classification) who presented within 3 weeks of injury were evaluated. Patients were treated with conventional medical (CM group, 20 eyes) management alone or combined with either UCS (UCS group, 17 eyes) or AMT (AMT group, 18 eyes). The parameters evaluated were time to epithelialisation, epithelial defect diameter, epithelial defect area, corneal clarity, tear break-up time (TBUT), Schirmer test and best-corrected vision. Results UCS and AMT groups showed early epithelialisation as compared with the CM group (Kaplan–Meier analysis=0.01). Mean time for healing of epithelial defect was 57.7±29.3, 27.4±19.0, 41.1±28.9 days in the CM, UCS and AMT groups, respectively (p=0.02). Mean TBUT at the last follow-up was 8.6±0.7, 10.3±1.1, 9.4±1.2 s in the CM, UCS and AMT groups, respectively (p=0.02). The mean Schirmer value at the last follow-up was 13.7±1.0, 16.9±3.0 and 13.2±1.5 mm in the CM, UCS and AMT groups, respectively (p=0.01). The visual outcomes and the occurrence of corneal vascularisation, symblepheron, ectropion and entropion were comparable in between the groups. Conclusions Our study suggests that the UCS therapy may be a better alternative to AMT in acute moderate to severe (grades III, IV and V) ocular Chemical Burns, as it avoids surgical manoeuvre in already inflamed eyes.
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evaluation of umbilical cord serum therapy in acute ocular Chemical Burns
Investigative Ophthalmology & Visual Science, 2011Co-Authors: Namrata Sharma, Jeewan S Titiyal, Thirumurthy Velpandian, Radhika Tandon, Rasik B Vajpayee, Manik GoelAbstract:PURPOSE To evaluate the role of umbilical cord serum therapy in cases of acute ocular Chemical Burns. METHODS In a double-blind prospective randomized controlled clinical study, 33 eyes of 32 patients with acute ocular Chemical Burns of grade III, IV, and V severity were randomized into three groups: umbilical cord serum (n = 12), autologous serum (n = 11), and artificial tears (0.5% HPMC+0.3% glycerin; n = 10). In addition, all eyes received standard medical therapy. The parameters evaluated were pain score, size, and area of epithelial defect, extent of limbal ischemia, corneal clarity, and symblepharon formation. The patients were followed up at day 1, 3, 7, 14, and 21 and at the end of months 1, 2, and 3. RESULTS Mean time to complete epithelialization was 21.16 ± 26.81, 56.6 ± 35.5, and 40.13 ± 35.79 days in cord serum, autologous serum, and artificial tears groups respectively (P = 0.02). By day 21, the mean percentage decrease in epithelial defect diameter was 94.63 ± 11.99 with cord serum compared with 53.17 ± 34.81 and 64.22 ± 42.43 with autologous serum and artificial tears, respectively (P = 0.01). By month 3, the extent of limbal ischemia with cord serum showed a mean percentage decrease of 73.43 ± 25.51 compared with 35.64 ± 25.60 and 43.71 ± 28.71 with autologous serum and artificial tears, respectively (P = 0.008). More patients had clear corneas with cord serum compared with autologous serum and artificial tears (P = 0.048). No significant difference was seen between the groups with regard to symblepharon formation (P = 0.07). CONCLUSIONS Umbilical cord serum therapy is more effective than autologous serum eye drops or artificial tears in ocular surface restoration after acute Chemical injuries. (www.controlled-trials.com number, ISRCTN08131903.).
Claes H Dohlman - One of the best experts on this subject based on the ideXlab platform.
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Chemical Burns of the eye the role of retinal injury and new therapeutic possibilities
Cornea, 2017Co-Authors: Claes H Dohlman, Fabiano Cade, Caio V Regatieri, Chengxin Zhou, Fengyang Lei, Alja Crnej, Mona Harissidagher, Marieclaude Robert, George N Papaliodis, Dongfeng ChenAbstract:Purpose To propose a new treatment paradigm for Chemical Burns to the eye - in the acute and chronic phases. Methods Recent laboratory and clinical data on the biology and treatment of Chemical Burns are analyzed. Results Corneal blindness from Chemical Burns can now be successfully treated with a keratoprosthesis, on immediate and intermediate bases. Long term outcomes, however, are hampered by early retinal damage causing glaucoma. New data suggest that rapid diffusion of inflammatory cytokines posteriorly (TNF-α, etc) can severely damage the ganglion cells. Prompt anti-TNF-α treatment is markedly neuroprotective. Long term profound reduction of the intraocular pressure is also vital. Conclusion A new regimen, in addition to standard treatment, for severe Chemical Burns is proposed. This involves tumor necrosis factor alpha (TNF-α) inhibition promptly after the accident (primarily for retinal neuroprotection), prophylactic maximal lowering of the intraocular pressure (starting immediately), and keratoprosthesis implantation in a later quiet state.
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Incidence of Stevens-Johnson Syndrome and Chemical Burns to the Eye.
Cornea, 2015Co-Authors: Michelle Lee White, Jisun Jang, James Chodosh, Claes H DohlmanAbstract:PURPOSE: This population-based observational study was designed to estimate the incidence and distribution of SJS-spectrum (Stevens-Johnson syndrome, toxic epidermal necrolysis, and toxic epidermal Necrolysis/Stevens-Johnson syndrome overlap) and Chemical Burns (alkali or acid burn of the cornea/conjunctiva) in the United States and extrapolate these numbers to the world. METHODS: All patients evaluated in 961 hospital-based US emergency departments between July 1, 2010, and June 30, 2012 were identified retrospectively using the Nationwide Emergency Department Sample (NEDS) from the Agency for Healthcare Research and Quality. SJS-spectrum and Chemical burn cases were identified using the International Classification of Diseases, Ninth Revision, Clinical Modification diagnostic codes. RESULTS: A mean of 3834 new SJS-spectrum cases per year were identified in the United States, resulting in an incidence rate of 12.35 new cases per million per year. Similarly, a mean of 15,865 new Chemical burn cases per year were identified, resulting in an incidence rate of 51.10 new cases per million per year. CONCLUSIONS: If the incidence of SJS-spectrum is approximately uniform the world-over, extrapolation from the US figure would amount to approximately 86,500 new cases per year in the world. Extrapolation of ocular Chemical Burns to the world is difficult because the incidence and severity are anticipated to be higher in the developing world than in the United States. Still, using a US incidence rate, a minimum of 357,710 burn accidents would be expected to occur worldwide every year; there are presently too few data available to calculate the degree of severity and bilaterality.
Jeanjacques Gicquel - One of the best experts on this subject based on the ideXlab platform.
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management of ocular surface Chemical Burns
British Journal of Ophthalmology, 2011Co-Authors: Jeanjacques GicquelAbstract:Severe forms of ocular surface Chemical Burns are responsible for conjunctivalisation and neovascularisation of the cornea often associated with recurrent corneal erosions.1 This hallmark of limbal stem cell deficiency (LSCD) can be associated with a variable destruction of the corneal stroma leading to heavy scarring or perforation in the worst cases. Conjunctival lesions can also be responsible for severe sequelae such as symblepharons and dry eyes. The prognosis of severe forms has improved during the last decade as a result of amniotic membrane transplantation (AMT) and the use of auto-2 or allo-3 limbal stem cell transplantation (LSCT). The severity of ocular surface Chemical Burns varies with the causative agent and the duration of exposure. The penetration depth in the anterior segment correlates with the pH, especially for alkalis. Acid Burns (pH<4): strong acids such as sulfuric acid, found in car batteries, or chlorhydric acid, used for swimming-pool cleaning, will denature, precipitate and coagulate corneal proteins. Protein coagulation generally acts as barrier preventing deeper penetration. It is responsible for a ‘ground glass’ appearance of the cornea. Alkali Burns (pH>10): strong bases such as baking soda or ammonia are lipophylic. They dissociate into a hydroxyl ion and a cation, and will destroy the epithelium, the stroma and the endothelium while they saponify cell membrane fatty acids.1 Hydroxyl ions will denature the collagen matrix. Penetration will keep occurring long after the initial exposure. In 5–15 min, strong bases can reach the anterior chamber and damage the iris, lens, iridocorneal angle and ciliary body. Hydrofluoridric acid, a weak acid found in antirust solutions, is an exeption. In its nonionised form, it behaves like an alkaline substance, penetrating the corneal stroma and leading to extensive anterior segment lesions. When it becomes ionised it will combine with intracellular calcium and magnesium ions, and …