Umbilical Cord Serum Eye Drops a Good Adjunct for Acute Ocular Chemical Burns

By Reuters Staff

November 24, 2014

NEW YORK (Reuters Health) - For acute moderate to severe ocular chemical burns, umbilical cord serum (UCS) eye drops may be a better option than amniotic membrane transplantation (AMT) because it avoids surgical manipulation in already inflamed eyes, researchers say.

Chemical burns to the eye are emergencies that require rapid assessment and treatment, they note in a paper online November 4 in the British Journal of Ophthalmology.

"The management of ocular chemical burns is both challenging and complex; the aims of therapy are to promote epithelialisation, control acute inflammatory reaction and prevent complications," write Dr. Namrata Sharma, from Dr. Rajendra Prasad Centre for Opthalmic Sciences, All India Institute of Medical Sciences, New Delhi, and colleagues.

Conventional medical therapy, including topical steroids, antibiotics, mydriatic cycloplegics, antiglaucoma therapy, citrate and ascorbate, often give "suboptimal results," they note. UCS and AMT are newer treatment modalities, which reduce ocular surface inflammation and promote epithelial growth.

In 2005, Dr. Sharma and colleagues demonstrated in a randomized controlled trial that epithelialization was faster with AMT compared with the conventional therapy in mild to moderate acute chemical burns. In 2011, a randomized trial suggested that UCS is superior to both autologous serum and conventional therapy in this patient group.

The aim of their current retrospective study was to compare the efficacy of UCS eye drops with AMT in the treatment of ocular chemical burns; to the best of their knowledge this is the first study to compare these treatment modalities.

The analysis involved 55 eyes (53 patients) with grades III, IV and V chemical burns. Twenty eyes were treated with conventional medical (CM) therapy alone, 17 with CM plus UCS and 18 with CM plus AMT. They were followed for a median of three months.

The researchers say there was no significant difference between UCS eye drops and AMT in the healing of the epithelial defect; both modalities proved superior to CM therapy.

These findings support previous studies indicating that both UCS and AMT are helpful adjuncts to CM management in ocular chemical burns, they say. "Both UCS and amniotic membranes are rich in growth factors and serum antiproteases, which stimulate proliferation of corneal epithelium and increase the tensile strength of wounds," they note.

The study also showed that UCS was superior to AMT in terms of a healthier ocular surface given that patients treated with the eye drops have longer tear breakup times and higher Schirmer values (p=0.02 and p=0.01, respectively).

"This finding is significant," they say, "as maintaining a wet ocular surface is essential for future reconstructive surgeries. One reason for this could be that UCS eye drops can be administered for prolonged periods, whereas, amniotic membrane is retained on the ocular surface for only a limited time period," (about 10 days on average), they point out. This may limit the total exposure and availability of growth factors to the surface of the eye.

"UCS has another significant advantage over AMT in that the surgery is avoided in the inflamed and painful eyes. A large number of chemical injuries occur in children in whom we can also avoid unnecessary general anaesthesia. UCS drops can also be used in patients with poor general health and those unfit for surgery," the researchers note.

They conclude, based on their findings, that UCS therapy "may be a better adjuvant to conventional management than AMT in cases of moderate to severe (grades III, IV and V) ocular chemical burns. The treatment option in our study was done as per the preference of the treating physician; however, this is the limitation of our study, and a more appropriate study design would have been a prospective randomised controlled trial. The potential drawback of use of UCS therapy routinely is the resource-limited settings, as the facility for the procurement of cord serum may not be available at all centres since it is not commercially available."

The authors did not respond to request for comment by press time.

SOURCE: http://bmj.co/1vu1zsx

Br J Ophthalmol 2014.

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