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Umang Mathur - One of the best experts on this subject based on the ideXlab platform.

  • Scleral Ischemia in Acute Ocular Chemical Injury: Long-Term Impact on Rehabilitation With Limbal Stem Cell Therapy.
    Cornea, 2018
    Co-Authors: Nidhi Gupta, Aastha Singh, Umang Mathur
    Abstract:

    PURPOSE This study describes the impact of scleral ischemia on globe survival in cases of acute Chemical Injury and the outcome of limbal stem cell transplant in these eyes. METHODS This is a single-center, retrospective case study that reviews outcomes in all patients with acute Chemical Injury of grades IV and above who presented within 6 weeks from Injury. The period of the study is between May 2012 and May 2017. Eyes presenting without scleral ischemia underwent amniotic membrane transplantation (group A), whereas eyes presenting with scleral ischemia underwent tenonplasty with amniotic membrane transplantation (group B). Simple limbal epithelial transplantation (SLET) was performed at 6 months in all consenting patients from both these groups. The primary outcome was defined as globe preservation at 3 months, whereas the secondary outcome was defined as SLET success at 1 year. RESULTS Twenty-three eyes of the 23 patients were included in our study. Of the 13 eyes in group B, 2 eyes developed phthisis and 2 eyes developed hypotony. None of the 10 eyes in group A developed hypotony or phthisis. The eyes that developed into hypotony and phthisis had presented with more extensive scleral ischemia (>180 degrees). In group B, 5 of 7 patients failed SLET. This was high compared with group A in which 2 of 8 patients failed SLET. CONCLUSIONS The presence and extent of scleral ischemia are important prognostic factors when assessing recovery in eyes with acute Chemical Injury. The authors recommend that it be added as a poor prognostic indicator in the existing classifications of acute Chemical Injury.

  • Early Results of Penetrating Keratoplasty in Patients With Unilateral Chemical Injury After Simple Limbal Epithelial Transplantation.
    Cornea, 2018
    Co-Authors: Nidhi Gupta, Javed Hussain Farooqui, Nikunj V Patel, Umang Mathur
    Abstract:

    Purpose To evaluate clinical outcomes of sequential PKP in eyes with unilateral Chemical Injury, which have previously undergone autologous simple limbal epithelial transplantation (SLET) at a tertiary eye center in North India. Methods This is a single-center, retrospective, noncomparative interventional case series reviewing patients with unilateral limbal stem cell deficiency treated by SLET and sequential PKP between 2012 and 2017. The primary outcome was defined as allograft survival, defined as a completely epithelialized, clear, avascular graft. The secondary outcome was improvement in best-corrected visual acuity by 2 lines or any complications. Results Seven eyes of 7 patients, all aged below 40 years, who underwent SLET followed by PKP for unilateral ocular surface Injury were included. Most of the patients were male (71.4%), and alkali Injury (42.8%) was the most common cause of limbal stem cell deficiency. The mean duration between SLET and PK was 9.5 ± 11.9 months (2-36 mo), and the mean follow-up duration after PKP was 15.1 ± 5.4 months (6-21 mo). A successful outcome after SLET was achieved in all 7 patients and clear grafts in 6 patients, with a graft survival rate of 85% at 6 months. Visual success was noted in 4 patients. Poor vision in 3 patients was due to glaucoma, amblyopia, and graft failure. Conclusions PKP was found to have a good outcome when the surface has been stabilized by SLET as an initial procedure in unilateral ocular Chemical Injury. The visual outcome was restricted mainly by other causes such as glaucoma and amblyopia.

Geetha Iyer - One of the best experts on this subject based on the ideXlab platform.

  • Allogenic Simple Limbal Epithelial Transplantation Versus Amniotic Membrane Grafting in the Early Management of Severe-Grade Ocular Chemical Injuries-A Retrospective Comparative Study.
    American journal of ophthalmology, 2020
    Co-Authors: Shweta Agarwal, Bhaskar Srinivasan, Rishi Gupta, Geetha Iyer
    Abstract:

    Purpose To compare outcomes of management in the early stage of severe Chemical Injury (grade 4 and worse; Dua classification) with amniotic membrane grafting (AMG) alone vs allogenic simple limbal epithelial transplantation (alloSLET). Design Retrospective comparative interventional case series. Methods Retrospective comparative interventional series. Records of patients with severe ocular Chemical Injury who underwent AMG alone (between 2009 and 2013) vs alloSLET (between 2013 and 2017) were analyzed for grade of Injury, time of and interventions for epithelial healing, ocular surface status post healing (grade of symblepharon, and limbal stem cell deficiency [LSCD]), and type of and need for interventions in the chronic stage. Results Among patients presenting in early stage of severe Chemical Injury, 38 eyes (median age 11 years) managed with AMG alone were compared with 39 eyes (median age 8 years) managed with alloSLET. The mean time of presentation post Injury was 33.85 ± 27.5 and 40.6 ± 23.5 days in the AMG and alloSLET group, respectively. The rate of epithelial healing was faster in the alloSLET group and the difference was noted to be statistically significant (odds ratio [OR] 0.966, P = .001). Similarly, the lower occurrence of LSCD (OR 0.137, P = .004) and need for keratoplasty (OR 0.093, P = .003) favored alloSLET over AMG. Final best-corrected visual acuity of >20/200 was achieved in 39.4% and 53.8% in the AMG and alloSLET groups, respectively. Conclusion AlloSLET helps in faster epithelialization of the surface, thus reducing the need for subsequent surgeries in the chronic stage and aiding faster visual rehabilitation. The outcomes of alloSLET appear superior to amniotic membrane grafting alone and should be considered in eyes with grade 4 and above (Dua classification) Chemical injuries in the early stage.

  • Algorithmic approach to management of acute ocular Chemical injuries-I's and E's of Management.
    The ocular surface, 2019
    Co-Authors: Geetha Iyer, Bhaskar Srinivasan, Shweta Agarwal
    Abstract:

    Ocular Chemical injuries are associated with significant morbidity leading to vision loss and ocular surface damage. Appropriate management and intervention in the acute stage dictates the final outcome as well as the prognosis for visual rehabilitative procedures in chronic stage. Classifying the parameters to be addressed in the acute stage and providing an algorithmic approach for managing the alterations in each of them will facilitate the primary goal of ensuring epithelialization of the ocular surface. Broadly categorizing them into the I's and E's (inciting agent, inflammation, epithelial defect, ischemia, exposure and intraocular pressure) and treating each will directly and/or indirectly influence re-epithelialization of the ocular surface, which in turn will reduce or prevent the various detrimental sequelae of ocular Chemical Injury.

  • Outcome of allo simple limbal epithelial transplantation (alloSLET) in the early stage of ocular Chemical Injury
    The British journal of ophthalmology, 2016
    Co-Authors: Geetha Iyer, Bhaskar Srinivasan, Shweta Agarwal, Anil Tarigopula
    Abstract:

    Purpose To analyse the outcome of allo simple limbal epithelial transplantation (alloSLET) in eyes in the early stage following ocular Chemical Injury to achieve rapid epithelialisation. Patients and methods Records of 18 eyes of 17 patients who underwent alloSLET between April 2013 and Jan 2016 were analysed retrospectively. Patients with grade 4 or worse Dua9s classification for Chemical Injury, who presented within a month of the Injury or with a non-healing epithelial defect since the Injury despite earlier medical or surgical interventions, were included in the study. The time to epithelialisation was the primary outcome measure and the best corrected visual acuity, the clinically assessed epithelial phenotype and symblepharon formation were the secondary outcome measures. Results The mean time to epithelialisation was noted to be 22.5±9.14 days. A best corrected visual acuity of better than 20/120 was achieved in 13 eyes in a mean duration of 33.06+10.73 days following alloSLET. Corneal phenotype with complete epithelialisation was achieved in the immediate postoperative period in 17 of the 18 eyes (94.11%). Seven eyes had a gradual failure of the allograft and 5 eyes underwent subsequent limbal autograft. Symblepharon formation involving one to two quadrants was noted in 3 eyes (16.7%). Conclusions AlloSLET seems to be a useful technique to achieve rapid epithelialisation in severe Chemical injuries thereby preventing the adverse effects of delayed epithelial healing. Visual rehabilitative procedures in the chronic phase of Chemical Injury, in most instances following an alloSLET in the acute stage, did not require keratoplasty, either lamellar or penetrating.

Virender S Sangwan - One of the best experts on this subject based on the ideXlab platform.

  • successful management of immunological rejection following allogeneic simple limbal epithelial transplantation slet for bilateral ocular burns
    Case Reports, 2013
    Co-Authors: Swapnil Bhalekar, Sayan Basu, Virender S Sangwan
    Abstract:

    A 41-year-old woman presented with bilateral total limbal stem cell deficiency, one year after Chemical Injury. She underwent allogeneic simple limbal epithelial transplantation (SLET) from a cadaveric donor in her right eye. One month later her unaided visual acuity (VA) improved to 20/100 from hand-motions. The corneal surface was avascular and epithelialised. Three months later, she presented with acute pain in right eye with peripheral corneal neovascularisation encircling the transplants, engorged and tortuous perilimbal vessels and diffuse epithelial haze. For a diagnosis of allograft rejection, pulse doses of intravenous methyl prednisolone with intensive topical steroids were administered. Her symptoms resolved in a week, confirming the diagnosis. She recovered her pre-rejection VA. She was maintained on systemic immunosuppressive agents. Her ocular surface continues to be stable. This case describes hitherto unknown clinical features of allograft rejection following SLET and emphasises the importance of continued immunosuppression in allogeneic limbal transplantation.

  • Ocular surface changes in limbal stem cell deficiency caused by Chemical Injury: a histologic study of excised pannus from recipients of cultured corneal epithelium
    Eye, 2008
    Co-Authors: A. Fatima, G Iftekhar, Virender S Sangwan, Geeta K Vemuganti
    Abstract:

    Purpose To report histopathologic changes of the ocular surface pannus in patients with severe limbal stem cell deficiency (LSCD). Methods Corneal and conjunctival pannus tissues from 29 patients undergoing ocular reconstruction with cultured limbal cell transplantation were included. The medical records of these patients were reviewed for demographics, aetiologic diagnosis, type of Injury, interval between the initial insult and excision of pannus, and medical history involving human amniotic membrane (HAM) or limbal transplantation. The paraffin-embedded tissues were reviewed for epithelial changes, type–degree of fibrosis, degenerative changes, vascular changes, conjunctivalization of corneal surface, and evidence of residual HAM. We attempted a clinicopathologic correlation to understand the pathogenesis of pannus formation in LSCD. Results The 29 tissues were from 29 eyes of patients with primary aetiology of Chemical burn in 89.6% (undetermined in 10.4%) of cases. The pannus showed epithelial hyperplasia in 62%, active fibrosis in 66%, severe inflammation in 21%, giant cell reaction in 28%, and stromal calcification in 14% cases. Goblet cells were seen over the cornea in 64% cases; their absence was associated with squamous metaplasia of the conjunctiva and with long duration of insult. Evidence of residual HAM was noted in 42% cases. Conclusions The commonest cause of severe LSCD is alkali-induced Injury. Goblet cells over the cornea were seen in 60% of cases. HAM used for ocular surface reconstruction could persist for long periods within the corneal pannus, thus raising the need for further studies with long-term follow-up.

  • ocular surface changes in limbal stem cell deficiency caused by Chemical Injury a histologic study of excised pannus from recipients of cultured corneal epithelium
    Eye, 2008
    Co-Authors: A. Fatima, G Iftekhar, Virender S Sangwan, Geeta K Vemuganti
    Abstract:

    To report histopathologic changes of the ocular surface pannus in patients with severe limbal stem cell deficiency (LSCD). Corneal and conjunctival pannus tissues from 29 patients undergoing ocular reconstruction with cultured limbal cell transplantation were included. The medical records of these patients were reviewed for demographics, aetiologic diagnosis, type of Injury, interval between the initial insult and excision of pannus, and medical history involving human amniotic membrane (HAM) or limbal transplantation. The paraffin-embedded tissues were reviewed for epithelial changes, type–degree of fibrosis, degenerative changes, vascular changes, conjunctivalization of corneal surface, and evidence of residual HAM. We attempted a clinicopathologic correlation to understand the pathogenesis of pannus formation in LSCD. The 29 tissues were from 29 eyes of patients with primary aetiology of Chemical burn in 89.6% (undetermined in 10.4%) of cases. The pannus showed epithelial hyperplasia in 62%, active fibrosis in 66%, severe inflammation in 21%, giant cell reaction in 28%, and stromal calcification in 14% cases. Goblet cells were seen over the cornea in 64% cases; their absence was associated with squamous metaplasia of the conjunctiva and with long duration of insult. Evidence of residual HAM was noted in 42% cases. The commonest cause of severe LSCD is alkali-induced Injury. Goblet cells over the cornea were seen in 60% of cases. HAM used for ocular surface reconstruction could persist for long periods within the corneal pannus, thus raising the need for further studies with long-term follow-up.

  • Amniotic membrane transplantation in acute Chemical and thermal Injury
    American journal of ophthalmology, 2000
    Co-Authors: Mittanamalli S Sridhar, Virender S Sangwan, Aashish K Bansal, Gullapalli N Rao
    Abstract:

    Abstract %PURPOSE: To present a case of Chemical Injury and a case of thermal Injury treated by amniotic membrane transplantation in acute phase. METHODS: Case reports. An eye with sodium hydroxide Injury, opaque cornea, and limbal ischemia of more than 180 degrees and an eye with hot tea Injury, opaque cornea, stromal edema, and scarring were treated by amniotic membrane transplantation within the first few weeks of Injury. RESULTS: In the eye with sodium hydroxide Injury, 4 months after amniotic membrane transplantation, the ocular surface is stable, superficial corneal scarring with vascularization is present, and visual acuity is 20/25. In the eye with thermal Injury, 6 months after amniotic membrane transplantation, the ocular surface is stable, but there is superficial scarring and vascularization, and visual acuity is 20/20. CONCLUSIONS: Amniotic membrane transplantation can be considered in Chemical Injury with severe limbal ischemia and in severe thermal Injury in acute phase. Long-term studies are warranted to evaluate further the efficacy of amniotic membrane transplantation in these clinical situations.

Nidhi Gupta - One of the best experts on this subject based on the ideXlab platform.

  • Scleral Ischemia in Acute Ocular Chemical Injury: Long-Term Impact on Rehabilitation With Limbal Stem Cell Therapy.
    Cornea, 2018
    Co-Authors: Nidhi Gupta, Aastha Singh, Umang Mathur
    Abstract:

    PURPOSE This study describes the impact of scleral ischemia on globe survival in cases of acute Chemical Injury and the outcome of limbal stem cell transplant in these eyes. METHODS This is a single-center, retrospective case study that reviews outcomes in all patients with acute Chemical Injury of grades IV and above who presented within 6 weeks from Injury. The period of the study is between May 2012 and May 2017. Eyes presenting without scleral ischemia underwent amniotic membrane transplantation (group A), whereas eyes presenting with scleral ischemia underwent tenonplasty with amniotic membrane transplantation (group B). Simple limbal epithelial transplantation (SLET) was performed at 6 months in all consenting patients from both these groups. The primary outcome was defined as globe preservation at 3 months, whereas the secondary outcome was defined as SLET success at 1 year. RESULTS Twenty-three eyes of the 23 patients were included in our study. Of the 13 eyes in group B, 2 eyes developed phthisis and 2 eyes developed hypotony. None of the 10 eyes in group A developed hypotony or phthisis. The eyes that developed into hypotony and phthisis had presented with more extensive scleral ischemia (>180 degrees). In group B, 5 of 7 patients failed SLET. This was high compared with group A in which 2 of 8 patients failed SLET. CONCLUSIONS The presence and extent of scleral ischemia are important prognostic factors when assessing recovery in eyes with acute Chemical Injury. The authors recommend that it be added as a poor prognostic indicator in the existing classifications of acute Chemical Injury.

  • Early Results of Penetrating Keratoplasty in Patients With Unilateral Chemical Injury After Simple Limbal Epithelial Transplantation.
    Cornea, 2018
    Co-Authors: Nidhi Gupta, Javed Hussain Farooqui, Nikunj V Patel, Umang Mathur
    Abstract:

    Purpose To evaluate clinical outcomes of sequential PKP in eyes with unilateral Chemical Injury, which have previously undergone autologous simple limbal epithelial transplantation (SLET) at a tertiary eye center in North India. Methods This is a single-center, retrospective, noncomparative interventional case series reviewing patients with unilateral limbal stem cell deficiency treated by SLET and sequential PKP between 2012 and 2017. The primary outcome was defined as allograft survival, defined as a completely epithelialized, clear, avascular graft. The secondary outcome was improvement in best-corrected visual acuity by 2 lines or any complications. Results Seven eyes of 7 patients, all aged below 40 years, who underwent SLET followed by PKP for unilateral ocular surface Injury were included. Most of the patients were male (71.4%), and alkali Injury (42.8%) was the most common cause of limbal stem cell deficiency. The mean duration between SLET and PK was 9.5 ± 11.9 months (2-36 mo), and the mean follow-up duration after PKP was 15.1 ± 5.4 months (6-21 mo). A successful outcome after SLET was achieved in all 7 patients and clear grafts in 6 patients, with a graft survival rate of 85% at 6 months. Visual success was noted in 4 patients. Poor vision in 3 patients was due to glaucoma, amblyopia, and graft failure. Conclusions PKP was found to have a good outcome when the surface has been stabilized by SLET as an initial procedure in unilateral ocular Chemical Injury. The visual outcome was restricted mainly by other causes such as glaucoma and amblyopia.

Shweta Agarwal - One of the best experts on this subject based on the ideXlab platform.

  • Allogenic Simple Limbal Epithelial Transplantation Versus Amniotic Membrane Grafting in the Early Management of Severe-Grade Ocular Chemical Injuries-A Retrospective Comparative Study.
    American journal of ophthalmology, 2020
    Co-Authors: Shweta Agarwal, Bhaskar Srinivasan, Rishi Gupta, Geetha Iyer
    Abstract:

    Purpose To compare outcomes of management in the early stage of severe Chemical Injury (grade 4 and worse; Dua classification) with amniotic membrane grafting (AMG) alone vs allogenic simple limbal epithelial transplantation (alloSLET). Design Retrospective comparative interventional case series. Methods Retrospective comparative interventional series. Records of patients with severe ocular Chemical Injury who underwent AMG alone (between 2009 and 2013) vs alloSLET (between 2013 and 2017) were analyzed for grade of Injury, time of and interventions for epithelial healing, ocular surface status post healing (grade of symblepharon, and limbal stem cell deficiency [LSCD]), and type of and need for interventions in the chronic stage. Results Among patients presenting in early stage of severe Chemical Injury, 38 eyes (median age 11 years) managed with AMG alone were compared with 39 eyes (median age 8 years) managed with alloSLET. The mean time of presentation post Injury was 33.85 ± 27.5 and 40.6 ± 23.5 days in the AMG and alloSLET group, respectively. The rate of epithelial healing was faster in the alloSLET group and the difference was noted to be statistically significant (odds ratio [OR] 0.966, P = .001). Similarly, the lower occurrence of LSCD (OR 0.137, P = .004) and need for keratoplasty (OR 0.093, P = .003) favored alloSLET over AMG. Final best-corrected visual acuity of >20/200 was achieved in 39.4% and 53.8% in the AMG and alloSLET groups, respectively. Conclusion AlloSLET helps in faster epithelialization of the surface, thus reducing the need for subsequent surgeries in the chronic stage and aiding faster visual rehabilitation. The outcomes of alloSLET appear superior to amniotic membrane grafting alone and should be considered in eyes with grade 4 and above (Dua classification) Chemical injuries in the early stage.

  • Algorithmic approach to management of acute ocular Chemical injuries-I's and E's of Management.
    The ocular surface, 2019
    Co-Authors: Geetha Iyer, Bhaskar Srinivasan, Shweta Agarwal
    Abstract:

    Ocular Chemical injuries are associated with significant morbidity leading to vision loss and ocular surface damage. Appropriate management and intervention in the acute stage dictates the final outcome as well as the prognosis for visual rehabilitative procedures in chronic stage. Classifying the parameters to be addressed in the acute stage and providing an algorithmic approach for managing the alterations in each of them will facilitate the primary goal of ensuring epithelialization of the ocular surface. Broadly categorizing them into the I's and E's (inciting agent, inflammation, epithelial defect, ischemia, exposure and intraocular pressure) and treating each will directly and/or indirectly influence re-epithelialization of the ocular surface, which in turn will reduce or prevent the various detrimental sequelae of ocular Chemical Injury.

  • Outcome of allo simple limbal epithelial transplantation (alloSLET) in the early stage of ocular Chemical Injury
    The British journal of ophthalmology, 2016
    Co-Authors: Geetha Iyer, Bhaskar Srinivasan, Shweta Agarwal, Anil Tarigopula
    Abstract:

    Purpose To analyse the outcome of allo simple limbal epithelial transplantation (alloSLET) in eyes in the early stage following ocular Chemical Injury to achieve rapid epithelialisation. Patients and methods Records of 18 eyes of 17 patients who underwent alloSLET between April 2013 and Jan 2016 were analysed retrospectively. Patients with grade 4 or worse Dua9s classification for Chemical Injury, who presented within a month of the Injury or with a non-healing epithelial defect since the Injury despite earlier medical or surgical interventions, were included in the study. The time to epithelialisation was the primary outcome measure and the best corrected visual acuity, the clinically assessed epithelial phenotype and symblepharon formation were the secondary outcome measures. Results The mean time to epithelialisation was noted to be 22.5±9.14 days. A best corrected visual acuity of better than 20/120 was achieved in 13 eyes in a mean duration of 33.06+10.73 days following alloSLET. Corneal phenotype with complete epithelialisation was achieved in the immediate postoperative period in 17 of the 18 eyes (94.11%). Seven eyes had a gradual failure of the allograft and 5 eyes underwent subsequent limbal autograft. Symblepharon formation involving one to two quadrants was noted in 3 eyes (16.7%). Conclusions AlloSLET seems to be a useful technique to achieve rapid epithelialisation in severe Chemical injuries thereby preventing the adverse effects of delayed epithelial healing. Visual rehabilitative procedures in the chronic phase of Chemical Injury, in most instances following an alloSLET in the acute stage, did not require keratoplasty, either lamellar or penetrating.