Clinical Spectrum and Treatment Approaches in Corneal Burns

Objectives: To evaluate the clinical findings, treatment modalities and long-term prognosis of chemical and thermal burns of the cornea. Materials and Methods: Twenty-one patients (27 eyes) who were followed at two centers for corneal chemical and thermal burns between 2001 and 2013 were included. Eyes were grouped into four grades according to the severity of burn using Roper-Hall classification. Age, gender, type of burn, follow-up duration, corrected visual acuity before and after treatment, treatment modalities and complications were recorded. Patients received medical treatment or combined surgical treatment including amniotic membrane transplantation (AMT), conjunctivolimbal autograft/allograft (CLAU/CLAL) transplantation, keratolimbal allograft (KLAL) or penetrating keratoplasty (PKP). Results: Patients had a mean age of 27.1±15.5 years (range, 6 months-56 years) and were followed for a mean 63.2±58.6 weeks (4- 160 weeks). Significant improvement was achieved with medical treatment alone in patients with grade I (4 eyes) and 2 burns (8 eyes). Patients with grade III burns (11 eyes) underwent CLAU (6 eyes), combined AMT/CLAU (3 eyes), AMT/CLAL (1 eye), or CLAL+PKP (1 eye), while patients with grade IV burns (4 eyes) had keratectomy+CLAL/AMT (1 eye), keratectomy+CLAL+PKP after recurrence with CLAU/AMT (1 eye), CLAU+PKP (1 eye), and AMT/KLAL+PKP (1 eye). All patients except the latter showed ocular surface stabilization with these procedures. Conclusion: Ocular burns cause severe impairment of the ocular surface. It is possible to achieve good results with appropriate medical treatment and surgeries including ocular surface reconstruction. (Turk J Ophthalmol 2015; 45: 182-187

A New Potential Cause in the Development of Toxic Anterior Segment Syndrome: Fibrin Glue

Objectives: To present a potential cause for toxic anterior segment syndrome (TASS). Materials and Methods: We report 4 cases of TASS that occurred following uneventful phacoemulsification and intraocular lens implantation. Results: The 4 cases were the first consecutive 2 cases of 2 different surgery days, 5 months apart. The most prominent sign of TASS was limbus-to-limbus corneal edema. Pain and/or intraocular pressure rise were also common. All surgical and presurgical procedures were checked after the first outbreak, whereas the second outbreak required further investigation. Fibrin glue remnants from preceding pterygium surgery with conjunctival autografting were found to be the potential cause. Despite intensive corticosteroid therapy, corneal edema did not resolve in 2 patients who underwent keratoplasty. Conclusion: TASS is a sight-threatening condition which requires thorough investigation for prevention of new cases. All steps must be carefully revised. (Turk J Ophthalmol 2014; 44: 280-3

Toksik ön segment sendromu için yeni bir etken: Fibrin Yapıştırıcı

Amaç: Toksik ön segment sendromuna (TÖSS) yol açan olası bir etkeni sunmak. Gereç ve Yöntem: Komplikasyonsuz fakoemülsifikasyon ve göz içi lensi yerleştirilmesi sonrasında TÖSS gelişen 4 olgu sunulmaktadır. Bulgular: Olgular, 5 ay ara ile iki ayrı ameliyat gününün ilk iki olgusu idi. TÖSS’nin en belirgin bulgusu limbustan limbusa uzanan kornea ödemiydi. Ağrı ve/veya göz içi basınç artışı da diğer sık bulgulardı. İlk olaydan sonra tüm cerrahi ve cerrahi öncesi basamaklar gözden geçirildi; ikinci olaydan sonra daha detaylı araştırma gerekti. Önceki ameliyat gününün son vakası olan otogreftli piterjiyum errahisinden arta kalan fibrin yapıştırıcı artıklarının sorumlu etken olduğu bulundu. Yoğun kortikosteroid tedavisine rağmen 2 hastada kornea ödemi düzelmedi ve hastalara keratoplasti yapıldı. Sonuç: TÖSS görmeyi tehdit eden bir durumdur ve yeni olguların önlenebilmesi için etkene yönelik yoğun araştırma gerektirir. Tüm basamaklar dikkatlice gözden geçirilmelidir. (Turk J Ophthalmol 2014; 44: 280-3)Objectives: To present a potential cause for toxic anterior segment syndrome (TASS). Materials and Methods: We report 4 cases of TASS that occurred following uneventful phacoemulsification and intraocular lens implantation. Results: The 4 cases were the first consecutive 2 cases of 2 different surgery days, 5 months apart. The most prominent sign of TASS was limbus-to-limbus corneal edema. Pain and/or intraocular pressure rise were also common. All surgical and presurgical procedures were checked after the first outbreak, whereas the second outbreak required further investigation. Fibrin glue remnants from preceding pterygium surgery with conjunctival autografting were found to be the potential cause. Despite intensive corticosteroid therapy, corneal edema did not resolve in 2 patients who underwent keratoplasty. Conclusion: TASS is a sight-threatening condition which requires thorough investigation for prevention of new cases. All steps must be carefully revised. (Turk J Ophthalmol 2014; 44: 280-3