Chemical Burns on the Eye: Treatment Options and Concerns

Chemical burns of the ocular surface

Hello Doctor: My family member previously suffered from an infection caused by Acanthamoeba.
Initially, the doctor treated my family member by scraping off the corneal epithelium and applying medication for the Acanthamoeba infection at a concentration higher than what is typically used.
Later, we felt uneasy about this treatment, so we switched to another hospital.
The doctor at this hospital indicated that such treatment resulted in the complete loss of the corneal epithelium, so they discontinued the Acanthamoeba medication to allow the corneal epithelium to regenerate.
However, after more than a month of treatment, including amniotic membrane surgery, the corneal epithelium would grow to a certain extent but then begin to detach, and the newly formed tissue was not transparent.
The doctor explained that this was due to damage to the limbal stem cells, and we were referred to a specialist in stem cells.
This specialist decided to suture my family member's eyelids to facilitate corneal epithelial growth.
After 10 days, the doctor reported that the cornea was growing but still had small holes, so they recommended maintaining the current status and continuing observation.
We currently have three main questions:
1.
Is the current treatment approach appropriate?
2.
We have heard from previous doctors about limbal stem cell transplantation and a procedure at Chang Gung Memorial Hospital that involves culturing oral mucosal epithelial cells ex vivo and then transplanting them to the eye (COMET):
1.
Which option is better?
2.
Given our current situation, should we not delay further? Would it be better to proceed as soon as possible?
3.
If we opt for the COMET procedure, can the original stem cells in the eye coexist with the oral mucosal cells?
4.
After the COMET procedure, will the oral cells only survive in the eye for a limited time, necessitating another surgery later?
5.
What are the costs involved?
3.
The current physician has provided us with very little information, and since we are not professionals, we do not know how to ask the right questions.
When we inquire about our concerns, the doctor often says to discuss it later.
We suspect that they may not want us to worry too much, or perhaps they genuinely cannot provide further judgments.
However, this approach leaves us feeling very uneasy, and we wonder if they have not considered the details thoroughly (as the first doctor’s actions led to the current situation).
Therefore, we hope to seek your opinion:
1.
Should we consider consulting other hospitals to hear different doctors' recommendations?
2.
However, due to health insurance regulations, the doctor will know if we seek evaluations at other hospitals.
Would this make the doctor feel uncomfortable?

A-Hua, 20~29 year old female. Ask Date: 2011/05/24

Dr. Guo Jinliang reply Ophthalmology

Acanthamoeba keratitis is inherently a challenging condition to treat, and the treatment approach must be determined based on the patient's specific situation.
However, the outcomes of treatment are often unsatisfactory.
The methods mentioned in the correspondence each have their indications, but the key remains that treatment should be guided by the patient's condition and the physician's judgment.
I must emphasize again that the difficulty in treating Acanthamoeba keratitis lies in the challenge of completely eradicating the Acanthamoeba, particularly in its cystic form.
Therefore, prolonged treatment is necessary.
It is advisable to discuss with your physician, as different circumstances will warrant various treatment options, making it essential to consult with the physician who has evaluated your case for clearer guidance.

Reply Date: 2011/05/24

More Info

Chemical burns to the eye, particularly from substances like acids or alkalis, can lead to significant ocular damage and complications, including corneal scarring, vision impairment, and even blindness. The treatment and prognosis depend heavily on the severity of the burn, the specific chemical involved, and the timeliness of the intervention.
In your case, it appears that your family member has undergone a series of treatments following a severe infection and subsequent corneal damage. The initial treatment involved scraping the corneal epithelium and using high-concentration medications, which can sometimes lead to complications if not monitored closely. The subsequent decision to halt the initial treatment to allow for the regrowth of the corneal epithelium was a prudent choice, especially considering the potential for further damage from aggressive treatments.

Current Treatment Assessment
1. Is the current treatment appropriate?
The approach of allowing the corneal epithelium to regenerate while using amniotic membrane grafts is a recognized method for promoting healing in cases of severe ocular surface damage. However, the fact that the epithelium is not adhering properly and remains opaque suggests that there may be underlying issues, such as damage to the limbal stem cells, which are crucial for maintaining a healthy corneal surface.

2. Limbal Stem Cell Transplantation vs. COMET Procedure:
- Limbal Stem Cell Transplantation is typically indicated when there is significant limbal stem cell deficiency, which can result from chemical burns or other ocular surface diseases. This procedure aims to restore the population of stem cells necessary for corneal health.

- COMET (Cultivated Oral Mucosal Epithelial Transplantation) involves using cultured oral mucosal cells to reconstruct the ocular surface. This method can be beneficial in cases where limbal stem cells are severely damaged or absent.

- Which is better? The choice between these procedures depends on the specific condition of your family member's eye and the extent of stem cell damage. A thorough evaluation by a specialist in ocular surface diseases is essential to determine the best course of action.

3. Timing of Intervention:
If there is a significant risk of further deterioration or if the current treatment is not yielding positive results, it may be advisable to pursue one of the surgical options sooner rather than later. Delaying treatment could lead to irreversible damage.

4. Compatibility of Cells:
If the COMET procedure is performed, the oral mucosal cells can coexist with any remaining limbal stem cells. However, the long-term viability of these cells in the ocular environment can vary, and follow-up procedures may be necessary.

5. Cost Considerations:
The costs associated with these procedures can vary widely based on the healthcare system, the specific hospital, and the complexity of the case. It is best to discuss this directly with the healthcare provider or the hospital's financial department.

Seeking Additional Opinions
1. Should you seek another opinion?
It is entirely reasonable to seek a second opinion, especially if you feel that the current medical team is not providing sufficient information or reassurance. Different specialists may offer new insights or alternative treatment options that could be beneficial.

2. Impact on Current Medical Team:
While it is natural to worry about how seeking another opinion might affect your relationship with the current medical team, most healthcare professionals understand that patients and their families may seek additional perspectives, especially in complex cases. Open communication about your concerns can help maintain a collaborative relationship.

Conclusion
In summary, chemical burns to the eye require careful and often aggressive management to prevent long-term complications. The current treatment strategy should be evaluated regularly, and if there are concerns about its effectiveness, exploring other surgical options or seeking additional opinions is advisable. Always prioritize clear communication with healthcare providers to ensure that all your questions and concerns are addressed adequately.

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