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Review
. 2019 Sep 2:7:25.
doi: 10.1186/s41038-019-0161-4. eCollection 2019.

Acute surgical vs non-surgical management for ocular and peri-ocular burns: a systematic review and meta-analysis

Kevin M Klifto  1   2 , Ala Elhelali  1 , Caresse F Gurno  3 , Stella M Seal  4 , Mohammed Asif  1   2 , C Scott Hultman  1   2
Affiliations
Review

Acute surgical vs non-surgical management for ocular and peri-ocular burns: a systematic review and meta-analysis

Kevin M Klifto et al. Burns Trauma. .

Abstract

Background: Burn-related injury to the face involving the structures of the eyes, eyelids, eyelashes, and/or eyebrows could result in multiple reconstructive procedures to improve functional and cosmetic outcomes, and correct complications following poor acute phase management. The objective of this article was to evaluate if non-surgical or surgical interventions are best for acute management of ocular and/or peri-ocular burns.

Methods: This systematic review and meta-analysis compared 272 surgical to 535 non-surgical interventions within 1 month of patients suffering burn-related injuries to 465 eyes, 253 eyelids, 90 eyelashes, and 0 eyebrows and evaluated associated outcomes and complications. The PubMed, Embase, Cochrane Library, Web of Science, and Scopus databases were systematically and independently searched. Patient and clinical characteristics, surgical and medical interventions, outcomes, and complications were recorded.

Results: Eight of the 14,927 studies queried for this study were eligible for the systematic review and meta-analysis, with results from 33 of the possible 58 outcomes and complications using Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) and Cochrane guidelines. Surgery was associated with standard mean differences (SMD) 0.44 greater visual acuity on follow-up, SMD 1.63 mm shorter epithelial defect diameters on follow-up, SMD 1.55 mm greater changes in epithelial diameters from baseline, SMD 1.17 mm2 smaller epithelial defect areas on follow-up, SMD 1.37 mm2 greater changes in epithelial defect areas from baseline, risk ratios (RR) 1.22 greater numbers of healed epithelial defects, RR 11.17 more keratitis infections, and a 2.2 greater reduction in limbal ischemia compared to no surgical intervention.

Conclusions: This systematic review and meta-analysis found that compared to non-surgical interventions, acute surgical interventions for ocular, eyelid, and/or eyelash burns were found to have greater visual acuity on follow-up, shorter epithelial defect diameters on follow-up, greater changes in epithelial diameters from baseline, smaller epithelial defect areas on follow-up, greater changes in epithelial defect areas from baseline, greater numbers of healed epithelial defects, more keratitis infections, and a greater reduction in limbal ischemia, possibility preventing the need of a future limbal stem cell transplantation.

Keywords: Burns; Eye; Eyebrows; Eyelashes; Keratitis; Ocular; Peri-ocular; Stem cell transplantation; Visual acuity.

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Conflict of interest statement

Competing interestsThe authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) flow chart summarizes the results of the screening process and final article selections
Fig. 2
Fig. 2
Risk of bias graph and summary: review authors’ judgments about each risk of bias item for each included study
See this image and copyright information in PMC

References

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