RESUMO
We aimed to evaluate the characteristics and colonization by pathogenic microorganisms of the ocular surface in patients in a burn center and to determine their association with sedation, mechanical ventilation, and periocular burn. We prospectively evaluated 40 patients during an 8-mo period. Five evaluations where performed, at baseline and weekly on four more occasions or until hospital discharge or death. On each visit, we assessed periocular burn, lid position, Bell's phenomenon, Schirmer's test, presence of chemosis, conjunctival hyperemia, and exposure keratopathy; conjunctival fornix swabs were taken for microbiology culture. Also, we documented the level of sedation, mechanical ventilation status, and systemic and ocular treatment. Absent Bell's phenomenon and chemosis were significantly different at baseline in patients under mechanical ventilation, sedation, and in those with a periocular burn. The cumulative incidence of exposure keratopathy was 22.5% and the cumulative incidence of ocular surface colonization by pathogenic microorganisms was 32.5%. Both outcomes were associated with mechanical ventilation and periocular burn. The most frequent pathogenic microorganisms on the ocular surface were Candida parapsilosis, Acinetobacter baumanii, and Pseudomonas aeuroginosa. We did not observe any case of a persistent epithelial defect, infectious keratitis, corneal perforation or corneal opacity in this cohort. Results from our study may benefit future patients by allowing better risk stratification and treatment strategies for the ocular surface care in burn units.
Assuntos
Queimaduras Oculares/complicações , Queimaduras Oculares/microbiologia , Adulto , Unidades de Queimados , Queimaduras Oculares/terapia , Feminino , Humanos , Hipnóticos e Sedativos/administração & dosagem , Masculino , México , Relaxantes Musculares Centrais/administração & dosagem , Estudos Prospectivos , Respiração Artificial , Fatores de RiscoRESUMO
PURPOSE: To evaluate the effect of metronidazole ophthalmic solutions on corneal neovascularization (CNV) in a rat model. METHODS: A chemical burn was created in the right central cornea of 40 rats. Animals were randomized and distributed into four study groups (n = 10 rats per group) designated Met_0.1%, Met_0.5%, sham, and untreated groups. Chemical-burned corneas in the Met_0.1% and Met_0.5% groups received ophthalmic solutions of 0.1 and 0.5% metronidazole, respectively. Corneas in the sham group received phosphate-buffered saline (metronidazole diluent). All treated eyes received ophthalmic solution at intervals of 6 h, for up to 30 days. Untreated corneas received no treatment. CNV was evaluated postinjury using corneal photographs at different evaluation time points. The main CNV outcome measures were: burn intensity, index of CNV, and percentage of vascularized corneal area. Five rats from each group were euthanized, on days 15 and 30; the samples were collected for histological analyses. Differences with P < 0.05 were considered significant. RESULTS: CNV was observed in the eyes from day 7 postinjury. However, the indices of CNV for the Met_0.1% and Met_0.5% groups were smaller than those for the sham and untreated groups (P < 0.05). Furthermore, corneas treated with 0.1 or 0.5% metronidazole had smaller vascularized areas compared to control corneas. On histological study, the presence of blood vessels confirmed clinical outcomes. CONCLUSIONS: Regular instillation of 0.1 or 0.5% metronidazole had a significant inhibitory effect for CNV on chemical burns induced in a rat model.
Assuntos
Córnea/patologia , Neovascularização da Córnea/tratamento farmacológico , Metronidazol/administração & dosagem , Animais , Anti-Infecciosos/administração & dosagem , Queimaduras Químicas/complicações , Córnea/efeitos dos fármacos , Neovascularização da Córnea/etiologia , Neovascularização da Córnea/patologia , Modelos Animais de Doenças , Relação Dose-Resposta a Droga , Queimaduras Oculares/complicações , Seguimentos , Masculino , Soluções Oftálmicas , Ratos , Ratos Wistar , Fatores de Tempo , Resultado do TratamentoRESUMO
PURPOSE: To evaluate the use of subconjunctival bevacizumab on corneal neovascularization in an experimental rabbit model for its effect on vessel extension, inflammation, and corneal epithelialization. METHODS: In this prospective, randomized, blinded, experimental study, 20 rabbits were submitted to a chemical trauma with sodium hydroxide and subsequently divided into two groups. The experimental group received a subconjunctival injection of bevacizumab (0.15 m; 3.75 mg), and the control group received an injection of 0.15 ml saline solution. After 14 days, two blinded digital photograph analyses were conducted to evaluate the inflammation/diameter of the vessels according to pre-established criteria. A histopathological analysis of the cornea evaluated the state of the epithelium and the number of polymorphonuclear cells. RESULTS: A concordance analysis using Kappa's statistic showed a satisfactory level of agreement between the two blinded digital photography analyses. The neovascular vessel length was greater in the control group (p<0.01) than in the study group. However, the histopathological examination revealed no statistically significant differences between the groups in terms of the state of the epithelium and the number of polymorphonuclear cells. CONCLUSIONS: Subconjunctival bevacizumab inhibited neovascularization in the rabbit cornea. However, this drug was not effective at reducing inflammation. The drug did not induce persistent corneal epithelial defects.
Assuntos
Inibidores da Angiogênese/uso terapêutico , Anticorpos Monoclonais Humanizados/uso terapêutico , Neovascularização da Córnea/tratamento farmacológico , Endotélio Corneano/efeitos dos fármacos , Inflamação/tratamento farmacológico , Ceratite/tratamento farmacológico , Inibidores da Angiogênese/administração & dosagem , Animais , Anticorpos Monoclonais Humanizados/administração & dosagem , Bevacizumab , Queimaduras Químicas/complicações , Cáusticos , Neovascularização da Córnea/etiologia , Neovascularização da Córnea/patologia , Modelos Animais de Doenças , Endotélio Corneano/crescimento & desenvolvimento , Queimaduras Oculares/complicações , Injeções Intraoculares , Ceratite/patologia , Masculino , Estudos Prospectivos , Coelhos , Distribuição Aleatória , Índice de Gravidade de Doença , Hidróxido de SódioRESUMO
PURPOSE: To evaluate the use of subconjunctival bevacizumab on corneal neovascularization in an experimental rabbit model for its effect on vessel extension, inflammation, and corneal epithelialization. METHODS: In this prospective, randomized, blinded, experimental study, 20 rabbits were submitted to a chemical trauma with sodium hydroxide and subsequently divided into two groups. The experimental group received a subconjunctival injection of bevacizumab (0.15 m; 3.75 mg), and the control group received an injection of 0.15 ml saline solution. After 14 days, two blinded digital photograph analyses were conducted to evaluate the inflammation/diameter of the vessels according to pre-established criteria. A histopathological analysis of the cornea evaluated the state of the epithelium and the number of polymorphonuclear cells. RESULTS: A concordance analysis using Kappa's statistic showed a satisfactory level of agreement between the two blinded digital photography analyses. The neovascular vessel length was greater in the control group (p<0.01) than in the study group. However, the histopathological examination revealed no statistically significant differences between the groups in terms of the state of the epithelium and the number of polymorphonuclear cells. CONCLUSIONS: Subconjunctival bevacizumab inhibited neovascularization in the rabbit cornea. However, this drug was not effective at reducing inflammation. The drug did not induce persistent corneal epithelial defects.
Assuntos
Animais , Masculino , Coelhos , Inibidores da Angiogênese/uso terapêutico , Anticorpos Monoclonais Humanizados/uso terapêutico , Neovascularização da Córnea/tratamento farmacológico , Endotélio Corneano/efeitos dos fármacos , Inflamação/tratamento farmacológico , Ceratite/tratamento farmacológico , Inibidores da Angiogênese/administração & dosagem , Anticorpos Monoclonais Humanizados/administração & dosagem , Queimaduras Químicas/complicações , Cáusticos , Neovascularização da Córnea/etiologia , Neovascularização da Córnea/patologia , Modelos Animais de Doenças , Endotélio Corneano/crescimento & desenvolvimento , Queimaduras Oculares/complicações , Injeções Intraoculares , Ceratite/patologia , Estudos Prospectivos , Distribuição Aleatória , Índice de Gravidade de Doença , Hidróxido de SódioRESUMO
PRECIS: During the 4 years of this study, we noted 66 cases of alkali ocular burns, or approximately 16 cases per year, nearly half (45.5%) of which are due to an assault. For grade 1 and 2 burns the time elapsed to reepithelialization appears to be shorter when rinsed with Diphoterine* versus physiological solution. PURPOSE: Comparison of the effectiveness of two rinsing solutions for emergency use: a physiological solution and an amphoteric solution (Diphoterine*, Laboratories Prevor, Valmondois, France). Description of the clinical and progressive characteristics of alkali burns treated at the University Hospital Center of Fort de France in Martinique (French West Indies). DESIGN: Prospective consecutive observational case series and nonrandomized comparative study. PARTICIPANTS: Sixty-six patients were included. The total number of burned eyes is 104. Forty-eight eyes (46%) were rinsed with physiological solution and 56 eyes (54%) with Diphoterine*. METHODS: All patients benefited from an ocular rinse with 500ml of physiological solution or Diphoterine*, followed by a complete ophthalmologic exam. The ocular injuries were classified according to the Roper-Hall modification of the Hughes classification system. The same standardized therapeutic protocol was applied and adapted to the seriousness of the burn. MAIN OUTCOME MEASURES: Demographic data, time to corneal reepithelialization, final best corrected visual acuity and complications were analysed. RESULTS: Twenty-eight (42.4%) patients have a unilateral burn and 38 (57.6%) patients have bilateral burns. In decreasing order of frequency, the circumstances surrounding the injury are: assaults in 45.5% of cases (n=30), work-related accidents in 32% of cases (n=31), and domestic accidents in 23% of cases (n=15). For grade 1 and 2 burns the time elapsed to reepithelialization appears to be shorter when rinsed with Diphoterine* versus physiological solution (respectively): 1.9+/-1 days versus 11.1+/-1.4 days (p=10(-7)) and 5.6+/-4.9 days versus 10+/-9.2 days (p=0.02). For grade 3 and 4 burns, there are complications in 11 cases (11.6%): 8 corneal opacities and 3 perforations. CONCLUSIONS: This study is the first conducted in humans that takes into account the type of ocular rinse product used in the progressive follow-up study of injuries. The time elapsed to reepithelialization is shorter with Diphoterine* for grade 1 and 2 burns. There are not enough cases of grade 3 and 4 burns to make a conclusion. Diphoterine* seems very effective in terms of its mechanism of action and the experimental and clinical results.
Assuntos
Álcalis , Queimaduras Químicas/tratamento farmacológico , Queimaduras Oculares/induzido quimicamente , Soluções Oftálmicas/uso terapêutico , Acidentes Domésticos , Acidentes de Trabalho , Adulto , Queimaduras Químicas/complicações , Queimaduras Químicas/fisiopatologia , Queimaduras Oculares/complicações , Queimaduras Oculares/tratamento farmacológico , Feminino , Humanos , Masculino , Doenças Profissionais/induzido quimicamente , Doenças Profissionais/complicações , Doenças Profissionais/tratamento farmacológico , Compostos Orgânicos , Estudos Prospectivos , Resultado do Tratamento , Violência , Cicatrização/fisiologiaRESUMO
PURPOSE: To evaluate the additional benefits of amniotic membrane transplantation (AMT) when combined with conjunctival limbal autograft (CLAU) in the treatment of chronic chemical burns. METHODS: Thirty eyes of 30 rabbits underwent a chemical burn to create limbal deficiency. Forty-five days later, the animals were randomized into three groups of 10 rabbits each. Eyes from group 1 were treated with CLAU, group 2 underwent CLAU and AMT, and group 3 served as control without surgery. Corneal vascularization and opacity were documented with external photographs at postoperative days 30, 60, and 90. The rabbits were killed 3 months after surgery, and their corneas divided into two halves. One half was prepared for hematoxylin-eosin and periodic acid-Schiff staining and the other for frozen sections and immunostaining with AM3 (to MUC 5AC mucin) and AE5 (to K3 keratin). Final clinical outcome was also scored using external photographs at the last follow-up examination. RESULTS: After chemical burn, all groups showed similar degrees of conjunctivalization. After transplantation, corneal vascularization was worse in controls at 60 and 90 days (p < 0.001). At 30 days, eyes from group 1 had less corneal opacity (p < 0.05). At 90 days, corneal opacity was worse in controls but the same in groups 1 and 2 (p < 0.05). At the same time, limbal deficiency was significantly worse in controls (p < 0.05) but similar between groups 1 and 2. Corneal phenotype was present in 70% of the eyes in group 1, 50% in group 2, but in 10% of the controls. Clinical success with clear corneas was significantly more common in groups 1 and 2 when compared with controls (p < 0.001). CONCLUSIONS: CLAU is effective in treating limbal deficiency. The concurrent AMT does not add benefits in this rabbit model of chemical burns.
Assuntos
Âmnio/transplante , Queimaduras Químicas/cirurgia , Túnica Conjuntiva/transplante , Córnea/cirurgia , Lesões da Córnea , Queimaduras Oculares/induzido quimicamente , Queimaduras Oculares/cirurgia , Animais , Vasos Sanguíneos/patologia , Queimaduras Químicas/complicações , Queimaduras Químicas/patologia , Catarata/etiologia , Cáusticos , Córnea/irrigação sanguínea , Córnea/patologia , Queimaduras Oculares/complicações , Queimaduras Oculares/patologia , Masculino , Coelhos , Hidróxido de Sódio , Transplante Autólogo , Resultado do TratamentoRESUMO
El entendimiento en profundidad de los diferentes mecanismos de daño, defensa y reparación que toman lugar en una causticación ocular, ha permitido tratar en mejor forma a estos pacientes. En la etapa aguda, la medida más importante continúa siendo la irrigación profusa del ojo en el mismo lugar del accidente. Lisis de adherencias, antibióticos, corticoides, hipotensores y citrato de sodio deben emplearse. En la etapa subaguda nuestro norte será promover la epitelización (lente de contacto blanda terapéutica, tarsorrafía) y, evitar y tratar la ulceración. En la etapa tardía deberemos tratar las complicaciones y uno de los procedimientos empleados es la rehabilitación de la superficie ocular, con el transplante de células epiteliales sanas; puede hacerse tan precozmente como cuatro semanas despúes de la causticación, siempre que la isquemia limbar haya pasado y el limbo se encuentre vascularizado