This single centre, randomised, parallel-controlled clinical trial compared the outcomes of patients with Roper-Hall grade IV ocular chemical injury that had conventional treatment vs. combined medical treatment and amniotic membrane transplantation (AMT). They followed up 60 patients between August 2006 and January 2014 for a minimum of one year. The patients were randomly assigned to two groups (30 patients to each group). Group 1 received topical preservative free lubricating gel and drops, Chloramphenicol, Betamethasone, Homatropine, oral vitamin C and Doxycycline. Group 2 received an AMT plus medical treatment provided to Group 1. The main outcome measure was the time taken for complete corneal epithelialisation. This took 72.6 (21-180) days in group 1 vs. 75.8 (46-170) days in Group 2 (p=.610). The secondary outcome was best-corrected visual acuity (BCVA) and central corneal neovascularisation. The mean BCVA was 2.06 (0.4-2.6) logMAR vs. 2.06 (1-2.9) logMAR in Groups 1 and 2 respectively. Group 1 developed more central corneal neovascularisation (73.3%) compared with Group 2 (53.3%), however, this was found to not be statistically significant (p=0.108). They concluded that there is no additional benefit in combined AMT and medical therapy, as it does not accelerate corneal epithelialisation or final BCVA in these patients. Although no additional benefit of AMT was found during this study previous research has suggested that it does help in patients with chemical ocular injuries. Further research is needed and other secondary outcomes assessed such as pain and quality of life.

Amniotic membrane transplantation in acute severe ocular chemical injury: a randomized clinical trial.
Eslani M, Baradaran-Rafii A, Cheung A, et al.
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Tasmin Berman

University of Liverpool, Liverpool, UK.

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