Clinical Practice Guidelines for Prevention, Diagnosis and Management of Early and Delayed-onset Ocular Injuries Due to Mustard Gas Exposure

doi:10.4103/jovr.jovr_253_16

. 2017 Jan-Mar;12(1):65-80.

doi: 10.4103/jovr.jovr_253_16.

Clinical Practice Guidelines for Prevention, Diagnosis and Management of Early and Delayed-onset Ocular Injuries Due to Mustard Gas Exposure

Zhale Rajavi¹, Sare Safi², Mohammad Ali Javadi², Mohammad Reza Jafarinasab¹, Sepehr Feizi³, Mohammadreza Sedighi Moghadam⁴, Khosrow Jadidi⁵, Mahmoud Babaei⁵, Armin Shirvani⁶, Alireza Baradaran-Rafii⁷, Hossein Mohammad-Rabei⁸, Hossein Ziaei¹, Mohammad Ghassemi-Broumand⁹, Siamak Delfaza Baher⁸, Mostafa Naderi⁵, Mahmoodreza Panahi-Bazaz¹⁰, Siamak Zarei-Ghanavati¹¹, Shahriar Hanjani¹², Hassan Ghasemi¹³, Ramin Salouti¹⁴, Mojgan Pakbin², Bahareh Kheiri²

Affiliations

¹ Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Ophthalmic Epidemiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
² Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
³ Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Ocular Tissue Engineering Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
⁴ Janbazan Medical and Engineering Research Center, Tehran, Iran.
⁵ Trauma Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran.
⁶ Standardization and CPG Development Office, Deputy of Curative Affairs, Ministry of Health and Medical Education, Tehran, Iran.
⁷ Ocular Tissue Engineering Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
⁸ Department of Ophthalmology, Torfeh Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
⁹ Department of Optometry, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
¹⁰ Department of Ophthalmology, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
¹¹ Department of Ophthalmology, Mashhad University of Medical Sciences, Mashhad, Iran.
¹² Department Research and Development, Parsian Clinic of Ophthalmology, Isfahan, Iran.
¹³ Department of Ophthalmology, Shahed University, Tehran, Iran.
¹⁴ Department of Ophthalmology, Shiraz University of Medical Sciences, Tehran, Iran.

PMID: 28299009
PMCID: PMC5340066
DOI: 10.4103/jovr.jovr_253_16

Clinical Practice Guidelines for Prevention, Diagnosis and Management of Early and Delayed-onset Ocular Injuries Due to Mustard Gas Exposure

Zhale Rajavi et al. J Ophthalmic Vis Res. 2017 Jan-Mar.

. 2017 Jan-Mar;12(1):65-80.

doi: 10.4103/jovr.jovr_253_16.

Authors

Affiliations

¹ Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Ophthalmic Epidemiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
² Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
³ Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Ocular Tissue Engineering Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
⁴ Janbazan Medical and Engineering Research Center, Tehran, Iran.
⁵ Trauma Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran.
⁶ Standardization and CPG Development Office, Deputy of Curative Affairs, Ministry of Health and Medical Education, Tehran, Iran.
⁷ Ocular Tissue Engineering Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
⁸ Department of Ophthalmology, Torfeh Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
⁹ Department of Optometry, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
¹⁰ Department of Ophthalmology, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
¹¹ Department of Ophthalmology, Mashhad University of Medical Sciences, Mashhad, Iran.
¹² Department Research and Development, Parsian Clinic of Ophthalmology, Isfahan, Iran.
¹³ Department of Ophthalmology, Shahed University, Tehran, Iran.
¹⁴ Department of Ophthalmology, Shiraz University of Medical Sciences, Tehran, Iran.

PMID: 28299009
PMCID: PMC5340066
DOI: 10.4103/jovr.jovr_253_16

Erratum in

Erratum: Clinical Practice Guidelines for Prevention, Diagnosis and Management of Early and Delayed-onset Ocular Injuries Due to Mustard Gas Exposure.
[No authors listed] [No authors listed] J Ophthalmic Vis Res. 2017 Apr-Jun;12(2):247. doi: 10.4103/2008-322X.205383. J Ophthalmic Vis Res. 2017. PMID: 28540025 Free PMC article.

Abstract

Purpose: To develop clinical practice guidelines (CPGs) for prevention, diagnosis, treatment and follow-up of ocular injuries caused by exposure to mustard gas.

Methods: The clinical questions were designed by the guideline team. Websites and databases including National Guidelines Clearinghouse, National Institute for Clinical Excellence, Cochrane, and PubMed were searched to find related CPGs and explore possible answers to the clinical questions. Since there were no relevant CPGs in the literature, related articles in Persian and English languages were extracted. Each article along with its level of evidence was summarized. Additionally, hand search was performed by looking the reference list of each article. Consequently, recommendations were developed considering the clinical benefits and side effects of each therapeutic modality. The recommendations were re-evaluated in terms of customization criteria. All recommendations along with the related evidence were scored from 1 to 9 by experts from all medical universities of Iran. The level of agreement among the experts was evaluated by analyzing the given scores.

Results: The agreement was achieved for all recommendations. The experts suggested a number of minor modifications which were applied to the recommendations. Finally, CPGs were developed with 98 recommendations under three major domains including prevention of injury, diagnosis and management of the acute and delayed-onset mustard gas ocular injuries.

Conclusion: Considering the lack of CPGs for the prevention, diagnosis, and management of mustard gas-induced keratitis, these recommendations would be useful to prevent the serious ocular complications of mustard gas and standardize eye care services to the affected individuals.

Keywords: Clinical Practice Guidelines; Eye Injury; Iran; Mustard Gas.

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Conflict of interest statement

There are no conflicts of interest.

Figures

**Figure 1**
Ocular injuries due to mustard gas exposure in acute phase. Reproduced from “Javadi MA, Feizi S. Mustard gas ocular injuries in chemical warfare victims. 1st ed. Tehran: FARHANG FARDA; 2014”.

**Figure 2**
Chronic and delayed--onset ocular injuries due to mustard gas exposure. Reproduced from “Javadi MA, Feizi S. Mustard gas ocular injuries in chemical warfare victims. 1st ed. Tehran: FARHANG FARDA; 2014”.

See this image and copyright information in PMC

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Erratum: Clinical Practice Guidelines for Prevention, Diagnosis and Management of Early and Delayed-onset Ocular Injuries Due to Mustard Gas Exposure.
[No authors listed] [No authors listed] J Ophthalmic Vis Res. 2017 Apr-Jun;12(2):247. doi: 10.4103/2008-322X.205383. J Ophthalmic Vis Res. 2017. PMID: 28540025 Free PMC article.

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References

1. Smith KJ. The prevention and treatment of cutaneousinjury secondary to chemical warfare agents. Application of these finding to other dermatologic conditions and wound healing. Dermatol Clin. 1999;17:41–60. - PubMed
1. Smith KJ, Skelton H. Chemical warfare agents. Their past and continuing threat and evolving therapies. Part I. Skin Med. 2003;2:215–221. - PubMed
1. Safarinejad MR, Moosavi SA, Montazeri B. Ocular injuries caused by mustard gas: Diagnosis, treatment, and medical defense. Mil Med. 2001;166:67–70. - PubMed
1. Solberg Y, Alcalay M, Belkin M. Ocular injury by mustard gas. Surv Ophthalmol. 1997;41:461–466. - PubMed
1. Watson AP, Griffin GD. Toxicity of vesicant agents scheduled for destruction by the Chemical Stockpile Disposal Program. Environ Health Perspect. 1992;98:259–280. - PMC - PubMed

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[1] Smith KJ. The prevention and treatment of cutaneousinjury secondary to chemical warfare agents. Application of these finding to other dermatologic conditions and wound healing. Dermatol Clin. 1999;17:41–60. - PubMed

[2] Smith KJ. The prevention and treatment of cutaneousinjury secondary to chemical warfare agents. Application of these finding to other dermatologic conditions and wound healing. Dermatol Clin. 1999;17:41–60. - PubMed

[3] Smith KJ, Skelton H. Chemical warfare agents. Their past and continuing threat and evolving therapies. Part I. Skin Med. 2003;2:215–221. - PubMed

[4] Smith KJ, Skelton H. Chemical warfare agents. Their past and continuing threat and evolving therapies. Part I. Skin Med. 2003;2:215–221. - PubMed

[5] Safarinejad MR, Moosavi SA, Montazeri B. Ocular injuries caused by mustard gas: Diagnosis, treatment, and medical defense. Mil Med. 2001;166:67–70. - PubMed

[6] Safarinejad MR, Moosavi SA, Montazeri B. Ocular injuries caused by mustard gas: Diagnosis, treatment, and medical defense. Mil Med. 2001;166:67–70. - PubMed

[7] Solberg Y, Alcalay M, Belkin M. Ocular injury by mustard gas. Surv Ophthalmol. 1997;41:461–466. - PubMed

[8] Solberg Y, Alcalay M, Belkin M. Ocular injury by mustard gas. Surv Ophthalmol. 1997;41:461–466. - PubMed

[9] Watson AP, Griffin GD. Toxicity of vesicant agents scheduled for destruction by the Chemical Stockpile Disposal Program. Environ Health Perspect. 1992;98:259–280. - PMC - PubMed

[10] Watson AP, Griffin GD. Toxicity of vesicant agents scheduled for destruction by the Chemical Stockpile Disposal Program. Environ Health Perspect. 1992;98:259–280. - PMC - PubMed

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Clinical Practice Guidelines for Prevention, Diagnosis and Management of Early and Delayed-onset Ocular Injuries Due to Mustard Gas Exposure

Affiliations

Clinical Practice Guidelines for Prevention, Diagnosis and Management of Early and Delayed-onset Ocular Injuries Due to Mustard Gas Exposure

Authors

Affiliations

Erratum in

Abstract

Conflict of interest statement

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