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    Amniotic Membrane in Severe Ocular Chemical Injury

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    Researchers have found that combined amniotic membrane transplantation (AMT) and medical therapy does not accelerate healing in severe ocular chemical injury.1 However, the data also show that routine med­ical therapy leads to a quiet, conjunctivalized cornea and deep fornices with minimal complications, making ocular surface reconstructive surgeries—including stem cell transplantation—possible.

    Patients and intervention. For this randomized study, 60 eyes of 60 patients with Roper-Hall grade IV ocular chemical injury were enrolled in the trial with a minimum follow-up of 12 months. Patients were assigned to two groups: Group 1 (30 eyes) received topical preservative-free lubricating gel and drops, chloramphenicol, betamethasone, homatropine, oral vitamin C, and doxycycline; Group 2 (30 eyes) received AMT on the entire ocular surface in addition to the medical treatment provided in Group 1.

    Outcome measures. The main outcome measure was the time to complete corneal epithelialization. Sec­ondary outcome measures were best-corrected visual acuity (BCVA) and neovascularization in the central 5 mm of the cornea. Patients were examined on post­operative days 1, 3, 7, 14, and 28; biweekly until three months; monthly until one year; and quarterly there­after. They were also assessed for the development of complications, such as glaucoma and symblepharon formation.

    Results. Mean follow-up time was 20.3 ± 2.5 months (13 to 24 months). Corneal epithelial defects healed within 72.6 ± 30.4 days (21 to 180 days) in Group 1, ver­sus 75.8 ± 29.8 days (46 to 170 days) in Group 2. Mean BCVA was 2.06 ± 0.67 logMAR (0.4 to 2.6) versus 2.06 ± 0.57 logMAR (1 to 2.9) in Groups 1 and 2, respective­ly (p = .85). Group 1 developed more central corneal neovascularization (22 eyes; 73.3%) compared to Group 2 (16 eyes; 53.3%). This, however, was not statistically significant (p = .108).

    Assessment. “AMT has been reported as a treatment option in the management of the ocular chemical injury,” said coauthor Medi Eslani, MD, at the University of Illinois College of Medicine in Chicago. However, he noted, “Most of the previous studies are nonrandom­ized with a mixed population. Based on this trial, AMT does not offer any advantage over conventional medi­cal therapy alone in terms of corneal epithelial healing, final visual acuity, and neovascularization in patients with severe ocular chemical injury.”

    —Arthur Stone

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    1 Eslani M et al. Am J Ophthalmol. Published online Nov. 9, 2018.

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    Relevant financial disclosures—Dr. Eslani: None.

    For full disclosures and the disclosure key, see below.

    Full Financial Disclosures

    Dr. Chen Singapore A*STAR Biomedical Research Council: S; Singapore National Research Foundation: S; Singapore Ministry of Education: S; Singapore Ministry of Health: S.

    Dr. Duncan NEI: S.

    Dr. Eslani None.

    Dr. Tam None.

    Disclosure Category

    Code

    Description

    Consultant/Advisor C Consultant fee, paid advisory boards, or fees for attending a meeting.
    Employee E Employed by a commercial company.
    Speakers bureau L Lecture fees or honoraria, travel fees or reimbursements when speaking at the invitation of a commercial company.
    Equity owner O Equity ownership/stock options in publicly or privately traded firms, excluding mutual funds.
    Patents/Royalty P Patents and/or royalties for intellectual property.
    Grant support S Grant support or other financial support to the investigator from all sources, including research support from government agencies (e.g., NIH), foundations, device manufacturers, and/or pharmaceutical companies.

     

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