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

Ghosh, Saurabh; Salvador-Culla, Borja; Kotagiri, Ajay; Pushpoth, Sreekumari; Tey, Adrian; Johnson, Zoë; Figueiredo, Francisco C

doi:10.1097/ico.0000000000001739

Cited by 37 publications

(37 citation statements)

References 23 publications

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“…A case series of all chemical eye injuries reporting to our casualty department demonstrated an incidence of 5.6 cases per 100,000 population. All four cases of Roper-Hall grade IV eye injuries in this case series developed total unilateral LSCD despite best management [13]. The reported incidence of severe chemical injury in the UK is 0.02 per 100,000 per annum, although this seems to be an underestimation when compared with our own data [14].…”

Section: Introductioncontrasting

confidence: 50%

Recent Advances in Stem Cell Therapy for Limbal Stem Cell Deficiency: A Narrative Review

2020

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Destruction of the limbus and depletion of limbal stem cells (LSCs), the adult progenitors of the corneal epithelium, leads to limbal stem cell deficiency (LSCD). LSCD is a rare, progressive ocular surface disorder which results in conjunctivalisation and neovascularisation of the corneal surface. Many strategies have been used in the treatment of LSCD, the common goal of which is to regenerate a self-renewing, transparent, and uniform epithelium on the corneal surface. The development of these techniques has frequently resulted from collaboration between stem cell translational scientists and ophthalmologists. Direct transplantation of autologous or allogeneic limbal tissue from a healthy donor eye is regarded by many as the technique of choice. Expansion of harvested LSCs in vitro allows smaller biopsies to be taken from the donor eye and is considered safer and more acceptable to patients. This technique may be utilised in unilateral cases (autologous) or bilateral cases (living related donor). Recently developed, simple limbal epithelial transplant (SLET) can be performed with equally small biopsies but does not require in vitro cell culture facilities. In the case of bilateral LSCD, where autologous limbal tissue is not available, autologous oral mucosa epithelium can be expanded in vitro and transplanted to the diseased eye. Data on long-term outcomes (over 5 years of follow-up) for many of these procedures is needed, and it remains unclear how they produce a self-renewing epithelium without recreating the vital stem cell niche. Bioengineering techniques offer the ability to recreate the physical characteristics of the stem cell niche, while induced pluripotent stem cells offer an unlimited supply of autologous LSCs. In vivo confocal microscopy and anterior segment OCT will complement impression cytology in the diagnosis, staging, and follow-up of LSCD. In this review we analyse recent advances in the pathology, diagnosis, and treatment of LSCD.

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Section: Introductioncontrasting

confidence: 50%

Recent Advances in Stem Cell Therapy for Limbal Stem Cell Deficiency: A Narrative Review

2020

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“…This correlates well with a recently published prospective study in the United Kingdom (UK). Based on 11,683 patients attending an emergency department over 6 months, the incidence was estimated to be 56 new cases per million [13]. This incidence rate may therefore closely reflect that of other developed countries.…”

Section: Adultsmentioning

confidence: 87%

“…This is followed by sodium hydroxide (3-5 min), potassium hydroxide (> 5 min) and calcium hydroxide (slowest and variable depending upon crystallisation) [28]. Therefore, ammonia is known to cause most severe ocular chemical burns [13] and is used commonly in assault cases. Lime is a much more common cause of chemical burns, but comparatively less toxic.…”

Section: Alkali Vs Acid Chemical Agentsmentioning

confidence: 99%

An update on chemical eye burns

Bizrah

Yusuf²,

Ahmad

2019

Eye

106

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Ocular chemical injuries vary in severity, with the more severe end of the spectrum having profound visual consequences and medicolegal implications. Grading of ocular injuries is critical for determining acute treatment and visual prognosis. Poor immediate management results in more challenging treatment of acute disease. Similarly, poorly controlled acute disease results in more treatment-resistant chronic ocular disease. Despite several decades of research and public health initiatives, simple and effective interventions such as wearing protective eyewear and immediate irrigation of eyes remain as key challenges. Education and prevention are therefore important public health messages. Hurdles in the acute management of disease include poor evidence-base for commonly used treatments (e.g. based on experimental animal studies), reduced treatment adherence rates and high clinic non-attendance rates. The evolution of treatment strategies, particularly limbal stem cell transplantation, has revolutionised the visual and cosmetic outcomes in chronic phases of disease. It is therefore increasingly important to consider tertiary referral for patients with limbal stem cell failure or vision-limiting corneal scarring.

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“…A large number of patients presented to our hospital due to chemical injuries, where a large number of chemical enterprises were located nearby. The reported incidence ranges from 1.5 per 100,000 to 13.3 per 100,000 [4,6,9]. In addition, 1480 cases suffering from chemical injuries were reported to the Victorian Poisons Information Centre in Australia, supporting a telephone-based advice service, but the incidence did not be calculated [10].…”

Section: Discussionmentioning

confidence: 99%

Clinical characteristics of patients hospitalized for ocular chemical injuries in Shanghai from 2012 to 2017

Jiang

Zhou

2020

Int Ophthalmol

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Purpose To summarize the clinical characteristics of patients with ocular chemical injuries and evaluate their potential relationship with the visual outcome by analyzing the medical records of these patients from January 1, 2012, to December 31, 2017. Methods This is a retrospective case series study. Patient data included age, gender, occupational classification, location of ocular chemical injury, initial and final best-corrected distance visual acuity (BCDVA), intraocular pressure (IOP), nature and chemical phase, distribution and severity of chemical injury, management methods, and complications. All variables were evaluated for their potential relationship with visual outcome. Results A total of 160 patients were hospitalized with ocular chemical injuries. Majority of the patients were factory workers and arrived at the consultation room less than 24 h after injury. The most common ocular injury setting, classification of severity, causative chemical, chemical phase, and complications were workplace, grade II, unknown and mixed substance, liquid, and elevated IOP, respectively. The risk factors for poor final BCDVA were identified as older age, poor initial BCDVA, and irrigation 24 h after injury (P \ 0.001, P \ 0.001, and P = 0.011, respectively). Conclusions We elaborate the clinical characteristics and outcomes of patients with ocular chemical injuries in Jinshan District, Shanghai. A comprehensive education program should be established and the use of protective eyewear should be promoted to prevent occupation-related ocular chemical injuries.

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

Cited by 37 publications

References 23 publications

Recent Advances in Stem Cell Therapy for Limbal Stem Cell Deficiency: A Narrative Review

Recent Advances in Stem Cell Therapy for Limbal Stem Cell Deficiency: A Narrative Review

An update on chemical eye burns

Clinical characteristics of patients hospitalized for ocular chemical injuries in Shanghai from 2012 to 2017

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