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   Table of Contents      
COMMENTARY
Year : 2019  |  Volume : 67  |  Issue : 1  |  Page : 37

Commentary: Assessment of limbal ischemia in ocular burns


Department of Cornea and Refractive Services, Aravind Eye Hospital, Madurai, Tamil Nadu, India

Date of Web Publication21-Dec-2018

Correspondence Address:
Dr. N Venkatesh Prajna
Director of Academics, Aravind Eye Hospital, 1, Anna Nagar, Madurai, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_1432_18

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How to cite this article:
Radhakrishnan N, Prajna N V. Commentary: Assessment of limbal ischemia in ocular burns. Indian J Ophthalmol 2019;67:37

How to cite this URL:
Radhakrishnan N, Prajna N V. Commentary: Assessment of limbal ischemia in ocular burns. Indian J Ophthalmol [serial online] 2019 [cited 2019 Aug 22];67:37. Available from: http://www.ijo.in/text.asp?2019/67/1/37/248123



“What gets measured appropriately and accurately, serves as an important benchmark for process improvement” is often quoted in management parlance signifying the importance of comprehensive assessments. The quality of assessments becomes much more useful as a benchmarking tool, when it is reproducible and repeatable. This paper by Kam et al.[1] highlights the fact about the inadequacies of the current clinical evaluation of ocular burns and calls for a refinement in the existing assessment protocols.

Ocular burns are catastrophic emergencies that can lead to significant visual morbidity.[2] Recovery of ocular surface and the visual morbidity depend on the extent and severity of ocular surface involvement at the acute insult.[3] Treatment protocols also vary with the severity of the injury and are often decided by the initial clinical assessment, and hence, a comprehensive method of examination is extremely critical for the eventual visual recovery. Timely management with amniotic membrane transplant and limbal stem-cell transplant have improved the final outcomes of moderate-to-severe chemical injury.[4]

In the current study, Kam et al, use slit lamp photographs of patients with different grades of chemical injury and analyze the interobserver agreement of limbal ischemia among various ophthalmic professionals who attended an ocular surface workshop. The authors concluded that the interobserver agreement was poor even among the various ophthalmic professionals. While the classifications proposed by Roper-Hall and Dua et al. serve as the current guidelines, studies such as the current ones bring about the limitations of reproducibility of these measurements.[5],[6] Although fluorescein staining can allow us to quantify the amount of limbal epithelial loss, limbal ischemia is still diagnosed and quantified on the basis of the area of blanching seen at the limbus in slit lamp biomicroscopy. Ancillary tests such as anterior segment angiography and optical coherence tomography (OCT) angiography have been used to assess the corneal neovascularization in chronic limbal stem-cell deficiency.[7],[8] However, their use in acute settings has not been fully elucidated. Clearly, the development of newer objective modalities to assess ocular surface following chemical injuries is the need of the hour which will help rationalize appropriate therapy.



 
  References Top

1.
Kam KW, Patel CN, Nikpoor N, Yu M, Basu S. Limbal ischemia: Reliability of clinical assessment and implications in the management of ocular burns. Indian J Ophthalmol 2019;67:32-6.  Back to cited text no. 1
  [Full text]  
2.
Oliva MS, Schottman T, Gulati M. Turning the tide of corneal blindness. Indian J Ophthalmol 2012;60:423-7.  Back to cited text no. 2
  [Full text]  
3.
Gupta N, Kalaivani M, Tandon R. Comparison of prognostic value of Roper Hall and Dua classification systems in acute ocular burns. Br J Ophthalmol 2011;95:194-8.  Back to cited text no. 3
    
4.
Iyer G, Srinivasan B, Agarwal S, Tarigopula A. Outcome of allo simple limbal epithelial transplantation (alloSLET) in the early stage of ocular chemical injury. Br J Ophthalmol 2017;101:828-33.  Back to cited text no. 4
    
5.
Roper-Hall MJ. Thermal and chemical burns. Trans Ophthalmol Soc U K 1965;85:631-53.  Back to cited text no. 5
    
6.
Dua HS, King AJ, Joseph A. A new classification of ocular surface burns. Br J Ophthalmol 2001;85:1379-83.  Back to cited text no. 6
    
7.
Ang M, Sim DA, Keane PA, Sng CC, Egan CA, Tufail A, et al. Optical coherence tomography angiography for anterior segment vasculature imaging. Ophthalmology 2015;122:1740-7.  Back to cited text no. 7
    
8.
Oie Y, Nishida K. Evaluation of corneal neovascularization using optical coherence tomography angiography in patients with limbal stem cell deficiency. Cornea 2017;36 Suppl 1:S72-5.  Back to cited text no. 8
    




 

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