AlloSLET vs AMG in the early management of severe grade ocular chemical injuries - A Retrospective Comparative Study.

Abstract Purpose To compare outcomes of management in the early stage of severe chemical injury (grade 4 and worse -Dua’s classification) with amniotic membrane grafting (AMG) alone versus alloSLET. Design Retrospective comparative interventional case series Materials and Method Retrospective comparative interventional series. Records of patients with severe ocular chemical injury who underwent AMG alone (between 2009-2013) versus alloSLET(between 2013- 2017) were analysed for grade of injury, time of and interventions for epithelial healing, ocular surface status post healing ( grade of symblepharon, and limbal stem cell deficiency [LSCD]) and type and need for interventions in the chronic stage. Results Among patients presenting in early stage of severe chemical injury, 38 eyes (median age 11 years) managed with AMG alone were compared with 39 eyes (median age 8 years) managed with alloSLET. The mean time of presentation post injury was 33.85+/- 27.5 and 40.6 +/- 23.5 days in AMG and alloSLET group respectively.The rate of epithelial healing was faster in the alloSLET group and the difference was noted to be statistically significant (Odds ratio [OR]-0.966 , p =0.001) . Similarly the lower occurrence of LSCD (OR-0.137, p =0.004) and need for keratoplasty (OR-0.093, p=0.003) favoured alloSLET over AMG .Final best corrected visual acuity of >20/200 was achieved in 39.4% and 53.8% in AMG and alloSLET groups respectively. Discussion AlloSLET helps in faster epithelisation of the surface thus reducing the need for subsequent surgeries in the chronic stage aiding faster visual rehabilitation. The outcomes of alloSLET appear superior to amniotic membrane grafting alone and should be considered in eyes with grade 4 and above (Dua’s classification) chemical injuries in the early stage.