Ophthalmologic sequelae of thermal burns over ten years at the Alfred Hospital

PURPOSE: To study the ocular outcomes of facial burns over a 10-year period at the Alfred Hospital; in particular, to investigate the impact of 3 variables (grading of burn, use of prophylactic ocular surface lubrication, and timing of ophthalmologic referral) on the requirements for eyelid surgery. METHODS: A retrospective review of patients admitted to the Alfred Hospital (from October 1990 to October 2000) after thermal burns with facial, eyelid, and ocular involvement. RESULTS: Sixty-six patients were identified with facial burns involving the lids or eyes, having been admitted over a 10-year period. Of these 66, 7 died of complications of the burns and 12 required eye or eyelid surgery. Of those patients treated with prophylactic ocular surface lubrication, the rate of ocular surgery was 18.4% as opposed to 30% when no prophylaxis was used. The higher the percentage of total burn, the later the referral was made. Of those with severe eyelid burns, 100% had eyelid surgery and 50% of moderate burns had eyelid surgery. Sixty percent of moderate eyelid burns that required surgery did not receive prophylaxis. Thirty-four of 66 patients had acute corneal involvement, but only 3 eyes of 118 had long-term corneal morbidity. CONCLUSIONS: The requirement for eyelid surgery was closely related to the severity of the eyelid burn. The presence of an acute corneal burn with epithelial loss was not a poor prognosticator. The use of prophylactic ocular surface lubrication may provide early corneal protection, thereby minimizing ulceration in patients who may otherwise have required surgery, especially in those with mild to moderate exposure. Prompt ophthalmologic examination and the early use of prophylactic ocular surface lubrication for the cornea are associated with less need for eyelid surgery in patients with moderate eyelid burns.     

Ocular and facial injuries associated with the use of immersion heaters in an inmate population

PURPOSE: To report ocular and facial injuries caused by the use of electric immersion heaters in an inmate population. DESIGN: Prospective observational case series. METHODS: Data were recorded over a six-month period on age, gender, mechanism of injury, examination, and treatment of Dallas County inmates who experienced ophthalmic injuries from immersion heaters and were referred to a tertiary-care center. RESULTS: Eight male inmates were treated for thermal ocular injuries, which occurred within jail cells as a result of cooking explosions from electric immersion heaters, known by inmates as "stingers." All patients had thermal eyelid burns, either first- or second-degree facial burns, and corneal abrasions with corneal edema. Corneal metallic foreign bodies were removed in one patient, and three patients underwent debridement for corneal sloughing. CONCLUSIONS: Immersion heater-related accidents may cause thermal injuries within the inmate population. Physicians evaluating incarcerated patients with ocular trauma should be aware of immersion heaters as a common cause.     

Eye injuries in children: the current picture

AIMS: To investigate the current causes and outcomes of paediatric ocular trauma. METHODS: A prospective observational study of all children admitted to hospital with ocular trauma in Scotland over a 1 year period. RESULTS: The commonest mechanism of injury was blunt trauma, accounting for 65% of the total. 60% of the patients were admitted with a hyphaema. Injuries necessitating admission occurred most frequently at home (51%). Sporting activities were the commonest cause of injury in the 5-14 age group. There were no injuries caused by road traffic accidents or fireworks. Patients were admitted to hospital for a mean of 4.2 days (range 1-25 days). One (1%) child had an acuity in the "visually impaired" range (6/18-6/60) and one (1%) was "blind" (6/60) in the affected eye. No child was bilaterally blinded by injury and none required blind or partial sight registration. CONCLUSION: This study has shown that the incidence of eye injuries affecting children has fallen. The outcome of ocular trauma has improved significantly, and for the first time paediatric injuries appear to have a better prognosis than injuries affecting adults.     

分期治疗眼部碱烧伤的临床观察

目的：探讨不同时期眼部碱烧伤综合治疗的效果。

方法：回顾分析2019-01/12我院收治的眼部碱烧伤患者124例166眼,根据病情的严重程度,采取多项综合治疗措施,分别应用药物及手术联合治疗,随访6～12mo,观察眼部碱烧伤愈合情况及疾病转归。

结果：治疗后所有患者症状缓解,患眼角膜结膜愈合,无感染发生,平均住院时间13d,其中治愈118眼(71.1%),好转43眼(25.9%),无效5眼(3.0%)。眼部碱烧伤Ⅰ度、Ⅱ度患者治疗后无并发症发生; Ⅲ度患者眼表修复及视力恢复情况好于Ⅳ度患者,且并发症发生率低于Ⅳ度患者。

结论：根据角膜结膜及眼睑损伤评估眼部碱烧伤程度,选择恰当的时机采取相应的治疗措施,给予全身及局部药物治疗,结合眼表冲洗、前房穿刺、羊膜移植、结膜瓣遮盖、角膜移植、角膜缘干细胞移植等综合治疗方法,可获得较好的临床疗效。     

Boston type 1 keratoprosthesis outcomes in ocular burns

Purpose: To report the outcomes of Boston type I keratoprosthesis (BKPro) in the management of ocular burn injuries. Methods: This was a prospective study including all cases of BKPro implantation for ocular burns at the External Diseases and Cornea Service of the Federal University of São Paulo, between February 2008 and February 2010. Ten patients (10 eyes) were enrolled. Procedures performed to manage ocular injury were identified, and data were collected regarding patients’ ocular history, surgical procedure(s) performed, and postoperative outcomes, including visual acuity, retention, complications and required surgical procedures. Results: A total of 11 Type 1 BKPro were implanted in 10 eyes of 10 patients. The mean follow‐up period was 25.7 ± 10.8 months. Preoperative best‐corrected visual acuity (BCVA) ranged from count fingers to light perception. Postoperative BCVA was better than 20/200 in 90% of the patients and better than 20/60 in 60% of the patients. The overall BKPro retention rate was 90%. The most common complications were retroprosthetic membrane formation (50%) and persistent corneal epithelial defect evolving to corneal melting (40%). Patients who underwent ocular surface procedures such as limbal transplantation prior to BKPRo implantation had a lower incidence of corneal melting/thinning (p = 0.07), although this was not statistically significant. Conclusion: The anatomical and functional results identified in this study support the use of BKPro in managing bilateral limbal stem cell deficiency secondary to ocular burns.     

Nonpreserved human amniotic membrane transplantation in acute and chronic chemical eye injuries

PURPOSE: To evaluate the safety and efficacy of nonpreserved amniotic membrane transplantation (AMT) with or without limbal autograft transplantation (LAT) in management of acute and chronic chemical eye injuries. METHODS: Amniotic membrane transplantation or AMT + LAT was performed on nine eyes of seven consecutive patients, five eyes with acute chemical burn and four eyes with limbal stem cell deficiency secondary to previous chemical burn. Nonpreserved amniotic membrane was used in all procedures. RESULTS: Five patients (71.5%) were men and two (28.5%) were women. The average age at the time of surgery was 32.7 +/- 10.9 years (range, 20-45). Mean follow-up after last surgery was 8.9 +/- 3.2 months (range, 6-14). The average epithelial healing time was 24.6 +/- 17.3 days (range, 3-45). At the end of the follow-up period, visual acuity improved in all eyes, inflammation subsided, and the subjective complaints decreased remarkably. CONCLUSION: AMT with nonpreserved amniotic membrane promoted epithelial healing, reduced surface inflammation, increased patient comfort, and decreased the extent and severity of vascularization when used in patients with acute chemical burns. When used in limbal stem cell deficiency owing to past chemical burns, AMT alone or in combination with LAT aided in ocular surface reconstruction. Infectious, inflammatory, or toxic/allergic reactions were not encountered in any patient owing to the use of nonpreserved amniotic membrane. Further studies are required to establish the safety and efficacy of preserved and nonpreserved AMT in ocular surface reconstruction.     

Failure of amniotic membrane transplantation in the treatment of acute ocular burns

AIM: To report the failure of amniotic membrane transplantation (AMT) for ocular surface reconstruction in patients with severe acute chemical and thermal burns. METHODS: Four eyes of three patients who suffered severe chemical (n=3) and thermal (n=1) burns were studied. The aim of AMT was to prevent symblepharon formation, promote conjunctival regeneration, inhibit corneal melting by promoting epithelialisation, and to protect the ocular surface while associated lid burns were treated. AMT was used to cover the entire ocular surface of all the severely burnt and ischaemic eyes, 2-3 weeks after the injury. Where indicated, AMT was repeated by itself or in combination with other procedures in all patients. RESULTS: Three of the four eyes developed symblepharon and progressive corneal melt requiring urgent tectonic keratoplasty. All four eyes had persistent epithelial defects. Less than 25% of conjunctival regeneration occurred in three eyes. Two eyes autoeviscerated, one patient underwent lid sparing exenteration for a painful blind eye and one eye became phthysical. CONCLUSIONS: AMT did not help to restore the ocular surface or preserve the integrity of the eye in all our patients with severe acute burns, when used by itself or in combination with other surgical procedures. This reflects the extreme severity of the ocular burns in these patients and, in turn, draws attention to the fact that the current classification system does not adequately reflect such severity. In the current system such burns would be grouped under grade IV injuries to the eye (more than 50% limbal ischaemia). The prognosis of patients with 100% limbal ischaemia is much worse than patients with just over 50% limbal ischaemia. This inadequacy of the classification system probably also explains the difference between outcomes of management of grade IV burns (with AMT) in this series, compared with others.     

Management of alkali burns : an 11-year retrospective review

OBJECTIVE: To review the spectrum of patients with alkali burns admitted over an 11-year period and to assess the clinical outcomes after the introduction of a standard alkali burn treatment protocol. DESIGN: Retrospective nonrandomized comparative study. PATIENTS AND INTERVENTIONS: A total of 121 patient records with alkali burns (n = 177 eyes) admitted to a tertiary hospital between 1987 and 1998 were reviewed. Eyes treated with a standard alkali burn treatment protocol, which included intensive topical steroids, ascorbate, citrate, and antibiotics, were compared with eyes treated by conservative management with antibiotics, and a short course of steroids. MAIN OUTCOME MEASURES: Time to corneal reepithelialization, final best-corrected visual acuity, and time to visual recovery, length of hospital stay, and complications were analyzed. RESULTS: The standard protocol tended to delay corneal reepithelialization by one day (P: = not significant) in eyes with grade 1 burns (n = 76) and by 2 days (P: = 0.04) in grade 2 burns (n = 52), with no difference in final visual outcome. There were 37 eyes with grade 3 burns. Those treated with the standard protocol showed a trend toward more rapid corneal reepithelialization. Twenty-seven of 29 (93%) eyes with grade 3 injuries achieved a final best-corrected visual acuity of 20/40 or better compared with 3 of 6 (50%) eyes not treated according to the standard protocol (P: = 0.02). Eyes with grade 4 burns (n = 12), whether treated with the standard protocol or not, required 10 to 12 weeks for corneal reepithelialization. There was no statistically significant difference in final visual acuity. CONCLUSIONS: On the basis of our findings, a number of recommendations can be made for the management of alkali injuries. Patients with a grade 1 or 2 injury do not require routine admission and do not benefit from the use of intensive treatment with ascorbate and citrate. A trend toward more rapid healing and a better final visual outcome were apparent in grade 3 burns, but our standard protocol made no difference in grade 4 burns.     

Prospective study of eye burns at the Fort de France University Hospital

PURPOSE: We report the results of a three-years prospective study focusing on ocular alkali burns conducted in the University hospital of Fort de France (French West Indies). PATIENTS AND METHODS: This case record survey included all alkali burns evaluated by ophthalmologists in the emergency unit of the Fort de France hospital. All recruited patients were either called to identify the alkali (pH determined with a Prolab pH-meter) or underwent an anterior chamber puncture showing evidence of an aqueous humor pH above 8. The recorded data were: age, gender, cause of burn, in case of aggression the relation between the victim and the aggressor, initial clinical findings, Ropper Hall classification. The therapeutic protocol was initiated according to this classification. The course of the ocular burn was noted. Economical and medicolegal consequences were assessed from duration of off work time and from information provided by the public prosecutor respectively. RESULTS: Twenty-four patients who had 39 burned eyes were included. Most ocular burns (18) were caused by aggressions with Alcali (ammonia, pH = 12.8). Most victims were men accused of adultery. In the West Indies, Alcali is thought to have power to drive away evil spirits. Most victims were young men (mean age 42 years). Eight court suits have been filed and in 5 cases the judge dismissed the charge. In 13 eyes, the delay to the first ocular wash was 30 minutes and resulted in serious ocular burn (Ropper Hall class 3 or 4). After application of the therapeutic protocol, 6 of these eyes recovered in an average 55 days; 3 required limbal autograft, 2 were successful. Three of these severe burns were complicated by spontaneous perforation (1 eye), atrophy (1 eye), and leucoma (1 eye). One patient was lost to follow-up. All minor ocular burns (Ropper Hall class 1 and 2) healed within an average 12 days (range 3-38 days). CONCLUSION: Particular circumstances of ocular alkali burns in Martinique (French West Indies) have been indentified in this study which established the seriousness of these burns and their social and sometimes legal consequences. The importance of prevention is emphasized. It would seem that minor ocular alkali burns do not require a treatment duration longer than 15 days. Finally, the clinical data reported in this study show that a delay of several minutes is required for the development of severe ocular alkali burns.     

Eye injuries in outpatient clinic of Department of Ophthalmology Medical University Gdansk in 1992-1993 and 2002-2003 years

The aim of this study was the statistical and epidemiological analysis of patients with eye injuries. We analyzed all patients attending the emergency department of Department of Ophthalmology Medical University in Gdansk over the period of 1992-1993 and 2002-2003 years. We determined the visual function (visual acuity- distance and near Snellen acuity test, intraocular pressure measurement, biomicroscopy, ophthalmoscopy, X- ray examination and US -examination) in two groups of subjects. The 6427 patients were subjected in the first period (37% with eye injuries). In the second period we examined 10512 patients (44% with eye injuries). A total of visits have been examined in the first period: 24.1% of patients were between 19-25 and 48% between 26-50 years. In the second group of patients 35.7% of patients were between 19-25 and 30.3% were between 26-50 years. In the both periods we observed mainly corneal injuries. Corneal foreign body and corneal abrasion were the most common etiology among close eye injuries in both groups. A total of visits have been examined: 7.78% with the first group and 8.95% was with burns. There were 1.89% in the first and 5.75% in the second period of severe eye injury such as penetrating ocular trauma, orbital fracture and intraocular foreign body. The main causative activity of ocular injuries in both groups was work (5.80% group I and 23.80% group II), assault (36.20% group I and 47.75% group II) and traffic accidents (4.84% group I and 12.05% group II). Results of our work indicated that ocular trauma is a common cause of improvement of visual acuity and a common cause of visit to the Emergency Department of Department of Ophthalmology.     

Epidemiology of severe eye injuries in childhood

The authors conducted a cross-sectional study of all ocular injury cases admitted to a children's hospital between January 1978 and December 1984. Of 222 injuries reviewed, 77 (35%) resulted in some visual deficit. Males were significantly overrepresented in all age groups with an average male:female ratio of 3.5:1. The distribution of injuries was: contusions, 114 (51%); penetrating lacerations, 62 (28%); foreign bodies and burns, 11 (5%); and nonpenetrating lacerations, 35 (16%). Sixteen (7%) ocular injuries were associated with BB gun pellets and six of these children (42%) were blinded in the injured eye as a result. Two other cases of blindness resulted from ocular penetration by homemade "Jinsang Stars," underscoring the adverse influence of media on children's games. Adult supervision could have potentially prevented most cases of permanent visual deficit. The authors suggest that legislation restricting the use of BB guns be passed and that a program of adult and child eye safety education including "eye watch" warnings on potentially hazardous toys be developed.     

Eye injuries in childhood: a retrospective investigation of 88 cases from 1988 to 2000

PURPOSE: To assess the frequency, causes, mechanisms, and functional outcomes of eye injuries in childhood. METHODS: A retrospective analysis of the hospital files of patients younger than 12 years admitted to the Institute of Ophthalmology of Verona University for eye injuries from January 1, 1988, to December 31, 2000. RESULTS: Eighty-eight cases of eye injuries (69 [78%] boys, 19 [22%] girls) were identified. The mean age at admission was 7.2 years. The most frequent causes of eye injuries were domestic accidents in patients younger than 6 years (25%) and accidents at play in those older than 6 years (35%). Scissors were the most frequent causative agents in children under 6 and toys, stones, and ball injuries in those over 6. Diagnoses, therapies implemented, ocular complications, and outcomes are reported. CONCLUSIONS: The major causes of eye injuries in childhood are preventable; thus more adequate adult supervision and educational and legislative measures are necessary and useful in order to reduce prevalence and morbidity of these accidents.     

Eye injuries from fireworks in Western Sweden

PURPOSE: To investigate the extent and type of as well as the circumstances connected with, ocular injuries caused by pyrotechnical products in the Western region of Sweden (1 750 000 inhabitants). METHODS: A three-year prospective observational study was carried out to register, interview and follow-up all patients with ocular injuries caused by fireworks. The patients were reported by all ophthalmologists in the area. RESULTS: 52 patients (72 injured eyes) were reported, 49 males and 3 females. 39 of 52 (75%) were younger than 18 years. 15 patients (including the three females) were bystanders. The injuries ranged from conjunctivitis to complete loss of the eye. The pyrotechnical device had been manipulated or misused in 19 (37%) of the 52 accidents. Seriousness of injury could not be correlated to type of device or to whether the injured person was active in launching the firework or not. 20 (38%) of the 52 patients had permanent damage to the eye. CONCLUSION: Ocular injuries from fireworks remain a problem. Preventive measures such as protective glasses and legislation are being discussed.     

Amniotic membrane extraction solution for ocular chemical burns

Purpose: To evaluate the efficacy of amniotic membrane extract (AME) for ocular chemical burns. Methods: Prospective non‐comparative interventional case series study. Consecutive 14 eyes of 11 patients with acute or chronic chemical burns, being recruited in one referral centre, received AME topically in combination with traditional treatment. Ocular discomfort, visual acuity, ocular surface inflammation, re‐epithelialization, corneal thickness, corneal neovascularization and symblepharon were evaluated. Results: Symptom relieved and ocular surface inflammation reduced dramatically in all eyes. Epithelial defect healed in all eyes with acute burns, in which less than 7 clock hours of limbus was involved, after 16.6 days (1–44 days) AME treatment. AME failed to close the epithelial defect in all eyes with chronic chemical burn coexisting diffuse limbal stem cell deficiency; however, the area of epithelial defect decreased to 58% (11.1%–68.2%) at final visit. During a follow‐up period of 8.2 months (6–11 months), visual acuity improved in 12 eyes (86%). There was mild neovascularization in three eyes with grade III and IV acute burns, and slow progress of neovascularization in chronic burns. Mild symblepharon developed in two eyes with grade III and IV acute burns, whereas there was no significant progress of symblepharon in chronic cases. Conclusions: Although it is a preliminary and uncontrolled study, topical application of AME is effective in reducing inflammation, promoting reepithelization in the treatment of chemical burns, especially for mild to moderate acute cases.     

Ocular firework injuries at New Year's eve

PURPOSE: To prospectively study mechanisms and injury characteristics of ocular firework burns. METHODS: A prospective analysis of all patients with firework injuries attending the Department of Ophthalmology, University of Vienna, between 1994 and 2001. We looked for classes of fireworks and mechanisms of injuries. The number of diagnoses was established and their severity classified. RESULTS: During this period (8 years) we identified 116 eyes of 102 patients. 67/102 (66%) of all injuries were caused by class II and III fireworks. Patients ranged between 4 and 83 years. Ocular injuries occurred more frequently in males (69, 68%) and affected the right eye in 53 patients (52.5%). Ocular firework injuries to minors (under the age of 18 years) occurred in 48 (49%). The most common types of injury were skin and corneal erosions and abrasions (32/116, 28%). 11/116 eyes (10%) had severe injuries. 8 of 11 severe injuries (72%) occurred in minors (<18 years). 2 patients (1.7%) developed permanent blindness. In 32/116 patients (28%), the ocular trauma resulted in visual impairment, mainly due to corneal scars or retinal pathologies. In all patients, the severity index was 1.4 +/- 0.8. In minors the severity index was 1.6 +/- 1.0, in adults 1.2 +/- 0.5 (p = 0.013). CONCLUSION: Injuries in minors were significantly more severe than those in adults. Possible preventive measures include legislation, education of minors and eye protection.     

Treatment of the sequelae of ocular burns using limbal transplantation

PURPOSE: To report the results of limbal transplantation in patients with severe ocular burns and limbal stem cell deficiency. PATIENTS AND METHODS: This series includes six autografts (unilateral ocular burns) and five allografts (bilateral ocular burns) performed in ten eyes of ten males with an average age of 43 years. The origin of the ocular burn was chemical in eight cases and thermal in the remaining two cases. The average time between the initial trauma and limbal transplantation was 79 months. The average size of limbal grafts was 190 degrees (range: 80-20 degrees for autografts and 120-360 degrees for allografts). Patients with allografts received oral cyclosporine in three cases, topical cyclosporine in one case, and intravenous methylprednisolone in one case. Eight patients underwent penetrating keratoplasty an average of 11 months after limbal transplantation (range: 5-24 months). RESULTS: The average follow-up time was 36 months (range: 7-77 months). The overall success rate of limbal transplantation (ocular surface improvement) was 73% (8/11). The success rate of penetrating keratoplasty was 63% (5/8). The average initial visual acuity was 0.4/10 and the average final visual acuity was 1.6/10. Visual acuity improved by two lines or more in seven cases. DISCUSSION: Limbal transplantation is a useful surgical technique in patients with severe ocular burns. However, results remain insufficient and new techniques such as limbal stem cell culture and transplantation are needed to improve the visual prognosis of these patients.     

Ocular trauma in the United States Army: hospitalization records from 1985 through 1994

PURPOSE: To determine the incidence of hospitalized ocular injury in the United States Army and evaluate specific types and external causes of these injuries. METHODS: A US Army database that captured all hospital discharge records for Army personnel admitted to military and civilian hospitals was used to determine incident episodes of ocular injury requiring hospitalization from 1985 through 1994. Denominator data were available from the US Army. RESULTS: The average annual incidence of hospitalization for a principal or secondary diagnosis of ocular trauma (total hospitalized ocular injury) was 77.1 per 100,000 persons (95% confidence interval, 75.1-79.2). There was a 38% decline in the rate of total hospitalized ocular injury during this 10-year period. Men had twice the rates of women over all age groups. The highest rate occurred in the 17- to 19-year age group, with rates of 220.7 and 123.4 per 100,000 in men and women, respectively. Whites had a higher rate than blacks and nonwhites-nonblacks. Almost a third of the injuries were contusions of the eye and adnexa. Among men, the leading causes were machinery or tools (21%), fights (18%), transport accidents (18%), and sports and training (11%). Only 7% were related to weaponry or war, and of these, 90% were from nonbattle activities. CONCLUSION: The type and cause of injury suggest that preventive measures may be effective in decreasing the incidence of ocular trauma requiring hospitalization in US Army personnel.     

羊膜移植治疗早期眼表碱性化学伤的临床观察

目的:探讨新鲜人羊膜移植术对中重度早期眼表碱烧伤的临床效果。方法:对32例41眼中重度早期眼表碱烧伤进行单层或多层羊膜移植术,联合局部给予典必殊眼液及眼膏点眼,术后随访6～18(平均12)mo。结果:Ⅱ～Ⅲ度眼表碱烧伤29眼,角膜上皮愈合良好。Ⅳ度烧伤12眼,6眼角膜上皮愈合良好,5眼发生持续性上皮糜烂,1眼角膜溶解穿孔,所有病例均无排斥反应及睑球粘连。结论:单纯羊膜移植术是Ⅱ～Ⅲ度早期眼表碱烧伤简单有效的治疗方法,但对Ⅳ度烧伤者疗效欠佳。     

Alkali burns of the eye: effect of immediate copious irrigation with tap water on their severity

PURPOSE: To examine the effect of immediate irrigation on ocular alkali burn. METHODS: Information on the injury, immediate irrigation, and ocular findings was retrospectively obtained from each patient's record. RESULTS: 36 patients (49 eyes) irrigated their eyes with tap water (the irrigation group) and 17 patients (29 eyes) did not (no irrigation group). The mean age of patients in the irrigation and no irrigation groups was 30 and 53 years, respectively. According to Hugher's classification, 76% of eyes in the irrigation group had grade 1 injury, while 86% of eyes in the no irrigation group had grade 2 injuries. Mean time from the injury until healing was 8 days in the irrigation group and 29 days in the no irrigation group, respectively. CONCLUSION: Immediate copious irrigation with tap water reduced the severity in alkali burns of the eye and shortened the healing time.     

Analysis of corneal surface evolution after moderate alkaline burns by using impression cytology

PURPOSE: To compare corneal surface evolution after moderate alkaline burns by impression cytology in patients treated with medical therapy or with amniotic membrane transplantation (AMT). METHODS: A prospective study of 24 eyes from 18 patients (13 men and 5 women) with moderate alkaline burns was performed. All patients were divided according to the clinical ocular severity and the therapy used. Twelve eyes were treated surgically with AMT and the other 12 eyes received only medical therapy. Corneal cytology was obtained immediately after the burns, and 1, 2, 5, and 9 months later. We differentiated between samples obtained from affected areas and areas not affected by the burns. Cellular size, nuclear size, and nuclear-cytoplasmic (N:C) ratio were examined in corneal epithelial cells, as was the presence of goblet cells in corneal epithelium. RESULTS: Nuclear size, cellular size, and N:C ratio in non-burn-affected corneal areas had no significant alterations in comparison with normal eyes. In contrast, in burn-affected corneal areas, these parameters were significantly worse, and the presence of goblet cells in corneal epithelium was frequent 1 month after severe burns. Cellular size, nuclear size, N:C ratio, and corneal conjunctivalization improved during the study in all patients, but corneal reepithelialization occurred earlier in patients treated with AMT than in patients with only medical therapy. CONCLUSION: Morphologic and morphometric analysis of corneal cells by impression cytology after ocular burns permits the establishment of cellular reepithelialization patterns in relation with limbal deficiency level and with clinical ocular severity. AMT improves corneal reepithelialization earlier than medical therapy in moderate alkaline burns.