Management of scleral melt

Public Awareness of Ocular Chemical Injuries: A Cross-Sectional Study in Lithuania

Background: Ophthalmic emergencies are acute conditions that progress rapidly, posing a significant threat to a patient's vision and requiring urgent intervention to prevent permanent visual impairment. This study aimed to assess the general awareness of ocular chemical burns and the adequacy of the immediate response measures while also seeking to improve the understanding of these injuries and contribute to promoting a healthier society. Methods: A comprehensive literature review was performed, and the most frequently reported questions were incorporated into the original survey. An anonymous questionnaire, available both online and in print, was developed to conduct a cross-sectional study to assess the general knowledge of the causes, symptoms, and appropriate first aid measures to be applied in cases of chemical ocular trauma. Results: Between April and May 2024, 175 individuals completed the questionnaire and were included in the study. More than half (54%) of the tested population demonstrated a poor level of knowledge about chemical ocular injuries, and only 30.9% of the respondents correctly indicated the need for imminent treatment. Twenty percent of the respondents could not identify whether alkalis or acids are more hazardous. Additionally, 5.7% of the respondents falsely considered consultation with an emergency department a priority before thorough irrigation. Most of the respondents (60.6%) incorrectly indicated that the appropriate first aid measures and treatment depend on the substance involved, and 68.1% of the respondents stated that treatment in the emergency department should be delayed, allowing for anamnesis collection and thorough examination. Conclusions: Ocular chemical injuries can substantially impact an individual's quality of life. The present study found that the public knowledge concerning ocular chemical trauma, and the necessary immediate treatment is insufficient. Public education is vital, as delaying prompt and thorough irrigation at the chemical injury site may result in irreversible complications.

Self-retained, cryopreserved amniotic membrane for a scleral defect caused by mitomycin C: A case report

Purpose

To report a case of scleral melting noted within weeks after symblepharon release and pterygium excision with peri-operative adjuvant topical Mitomycin C (MMC) that was salvaged with in-office cryopreserved membrane.

Observations

A 61-year-old Hispanic gentleman with history of pterygium excision many years prior underwent right nasal pterygium excision and symblepharon release using bare sclera technique followed by topical MMC 0.1 % for a week, 16 years ago. He was noted to have a right nasal scleral thinning. He was successfully treated conservatively with in-office cryopreserved amniotic membrane without further progression of the scleral melting or surgical intervention required.

Conclusions and Importance

Short-term complication of pterygium excision with adjuvant topical MMC may occur. This case shows that early detection and recognition of the complication can be sight-saving with in-office cryopreserved amniotic membrane.

Topical erythropoietin for the management of scleral necrosis after ocular chemical burns

PURPOSE

To evaluate the efficacy of topical erythropoietin for chemical burn induced scleral necrosis.

METHODS

This study included 18 eyes of 16 patients with chemical burn induced scleral necrosis who presented within 6 weeks of the injury. In the prospective arm, 11 eyes received topical erythropoietin, 3000 IU/mL every 6 h, along with standard medical treatment. Retrospectively, we included 7 consecutive eyes of 7 patients who were managed with conventional treatment as historical control group. The main outcome measure was healing of avascular scleral lesions. The secondary outcome measure was complete re-epithelization of cornea.

RESULTS

Mean patient age was 39.8 ± 16.2 years in the erythropoietin group, and they presented 16.6 ± 15.2 days after acute chemical injury. Scleral necrosis improved in all eyes after 30.7 ± 23.2 days of treatment with topical erythropoietin. Corneal epithelial defects were completely healed in 10 eyes 61.9 ± 50.7 days after the start of the medication. In comparison, standard medical treatment alone did not improve scleral necrosis in the historical control group, necessitating ocular surface reconstruction including conjunctival advancement (1 eye) and tenonplasty (6 eyes).

CONCLUSION

The results of our study showed that topical erythropoietin was effective in the management of chemical burn induced scleral necrosis. This treatment could avoid ocular surface reconstruction procedures in inflamed eyes.