The edition · Ophthalmology
Carbide gun eye burns: early amniotic membrane transplantation gave good short-term results in a small Indian series
Also: switching biologics in uveitis that failed anti-TNF therapy, reversal of disc cupping after congenital glaucoma surgery, geographic atrophy and an oral vitamin A analogue, and postpartum glaucoma in women who were suspects.
The edition in brief
A retrospective series of 20 eyes from 18 patients with thermochemical burns from carbide guns during Diwali, all treated with irrigation, standard medical therapy and overlay amniotic membrane transplantation, found complete epithelialisation in all eyes, visual acuity improving from logMAR 1.77 to 0.77 at three months, repeat transplantation in 21% and no secondary glaucoma, with one eye with delayed presentation progressing to phthisis. A meta-analysis of 136 studies (mostly case series) found a pooled response rate of 83% after switching biologic in anti-TNF-refractory non-infectious uveitis, with higher response after switching class (89%) than within the anti-TNF class (77%), on low-certainty evidence. A review of 1,223 eyes found optic disc cupping reversal in 43.2% after surgery for primary congenital glaucoma, more likely with smaller corneal diameter and earlier onset. A June trial of 198 people with geographic atrophy missed its primary endpoint of lesion growth for an oral vitamin A analogue, with exploratory secondary signals. A cohort of 92 glaucoma suspects found postpartum progression to glaucoma in 57.6%, linked to pre-eclampsia and higher intraocular pressure. The pearl restates immediate irrigation for chemical eye injury.
Switching biologic in anti-TNF-refractory uveitis: most patients responded, with higher response when the class changed
Consider switching biologic after anti-TNF failure in uveitis, with a slight edge for changing class, on low-certainty evidence.
Optic disc cupping reversed in 43% of eyes after surgery for primary congenital glaucoma
Worth knowing when counselling parents: disc cupping often reduces after congenital glaucoma surgery, more so with early onset and smaller eyes.
An oral vitamin A analogue missed its primary endpoint in geographic atrophy
Worth knowing only as a lead: the oral agent missed its primary endpoint, and exploratory signals need a larger trial.
Glaucoma suspects who developed pre-eclampsia progressed to glaucoma more often after pregnancy
Consider closer postpartum review for glaucoma suspects who had pre-eclampsia; this is a small retrospective cohort.
For a chemical or thermal eye injury, irrigate first and examine afterwards
Irrigate at once and for long; assessment and referral come after.
Carbide gun eye burns: early amniotic membrane transplantation did well in 20 eyes
Consider early referral for amniotic membrane transplantation after significant carbide gun burns; this is uncontrolled evidence from 20 eyes.
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