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Acute Chemical Eye Injury and Limbal Stem Cell Deficiency - A Prospective Study in the United Kingdom

Lookup NU author(s): Professor Francisco Figueiredo

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Abstract

PURPOSE: To analyze the incidence, nature, outcomes, and complications of acute chemical eye injuries, including the incidence of limbal stem cell deficiency (LSCD) and to compare the 2 main classifications for ocular chemical injuries: Roper-Hall (RH) and Dua. METHODS: This is a prospective, consecutive, interventional single-center study between April and October 2009 of all new patients with acute chemical eye injury presenting to the Royal Victoria Infirmary eye emergency department (EED). RESULTS: Of 11,683 patients who attended the EED, 98 patients (110 eyes) presented with acute chemical eye injury (60% male). This represents an estimated annual incidence of 5.6 new cases per 100,000 population. Mean age was 36.5 years (1-78; SD 17.1 years), including 7 children (age <10 years). Fifty-one patients (52%) had work-related injuries. The most common chemical agent was alkali (78%). All 4 RH grade IV cases were unilateral, assault with ammonia, and required early amniotic membrane transplantation as per the protocol, but despite full treatment, they developed total LSCD in the affected eye. CONCLUSIONS: Acute chemical eye injuries are rare. Male patients in the working age group are more prone to work-related chemical injuries, whereas young children tend to have domestic injuries. Grade I, II, and III RH and Dua chemical injuries had a very good prognosis with topical treatment only, whereas RH grade IV (Dua grade IV-VI), mainly assaults with ammonia, progressed to total/severe LSCD despite appropriate management including early amniotic membrane transplantation. The Dua classification includes conjunctival involvement, having a greater value in predicting the final clinical outcome when grading chemical eye injuries.


Publication metadata

Author(s): Ghosh S, Salvador-Culla B, Kotagiri A, Pushpoth S, Tey A, Johnson ZK, Figueiredo FC

Publication type: Article

Publication status: Published

Journal: Cornea

Year: 2019

Volume: 38

Issue: 1

Pages: 8-12

Print publication date: 01/01/2019

Acceptance date: 02/04/2018

ISSN (print): 0277-3740

ISSN (electronic): 1536-4798

Publisher: Lippincott Williams & Wilkins

URL: https://doi.org/10.1097/ICO.0000000000001739

DOI: 10.1097/ICO.0000000000001739

PubMed id: 30199398


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