Evaluation of amniotic membrane transplantation as an adjunct to medical therapy as compared with medical therapy alone in acute ocular burns.
OBJECTIVE
To evaluate the role of amniotic membrane transplantation (AMT) in acute ocular burns.


METHODS
Prospective, randomized, controlled clinical trial.


METHODS
Patients with grade II to IV ocular burns within 3 weeks of injury were recruited. Thirty-seven patients, 7 of whom had bilateral involvement (total, 44 eyes), participated in the trial. Twenty eyes were included in group A (AMT) and 24 eyes were included in group B (controls).


METHODS
The eyes in the AMT group underwent AMT in addition to conventional medical therapy. In the control group, only conventional medical therapy was instituted.


METHODS
The patients' subjective assessments of relief of ocular discomfort, healing of the corneal epithelial defect, visual acuity, extent of corneal vascularization, formation of symblepharon, and tear function tests.


RESULTS
At day 1, subjective ocular discomfort scores were reduced significantly in eyes with moderate burns in the AMT group compared with controls (P = 0.05), but there was no difference between the 2 groups in eyes with severe burns. The log mean percentage reduction in size of epithelial defect by day 7 was 7.43+/-0.89 after AMT and 6.23+/-1.10 with medical treatment alone in moderate grade burns at day 7 (P = 0.01), but there was no difference between the 2 groups in eyes with severe burns. There was no overall difference in the final visual acuity, symblepharon formation, corneal vascularization, and tear function tests between the 2 groups over the next 3 months and further follow-up. There was a high dropout rate for long-term follow-up.


CONCLUSIONS
Amniotic membrane transplantation in eyes with acute ocular burns has advantages in terms of reduction of pain and promotion of early epithelialization in patients with moderate grade burns, but not so in severe burns. There seems to be no definite advantage to AMT over medical therapy alone in terms of improvement in visual acuity, appearance of symblepharon, corneal vascularization, and results of tear function tests on short-term follow-up.
Tamhane
Amol
A
Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.
Vajpayee
Rasik B
RB
Biswas
Nihar R
NR
Pandey
Ravindra M
RM
Sharma
Namrata
N
Titiyal
Jeewan S
JS
Tandon
Radhika
R
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000650:Amnion / Q000637:transplantation*; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D001205:Ascorbic Acid / Q000008:administration & dosage; D002057:Burns, Chemical / Q000188:drug therapy / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D002951:Citrates / Q000008:administration & dosage; D003131:Combined Modality Therapy; D003315:Cornea / Q000098:blood supply; D003316:Corneal Diseases / Q000188:drug therapy / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D004359:Drug Therapy, Combination; D005126:Eye Burns / Q000139:chemically induced*; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D009883:Ophthalmic Solutions / Q000008:administration & dosage*; D011446:Prospective Studies; D000077559:Sodium Citrate; D013666:Tears / Q000378:metabolism; D014326:Tropanes / Q000008:administration & dosage; D014945:Wound Healing
D000900:Anti-Bacterial Agents; D002951:Citrates; D005938:Glucocorticoids; D009883:Ophthalmic Solutions; D014326:Tropanes; D000077559:Sodium Citrate; C100236:homatropine; D001205:Ascorbic Acid