ascorbic-acid and Burns--Chemical

A short cut review was carried out to establish whether ascobate drops are useful in the management of alkalis burns to the eyes. Altogether 33 papers were found using the reported search, of which one presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of this best paper are tabulated. A clinical bottom line is stated.

Topics: Adult; Alkalies; Ascorbic Acid; Burns, Chemical; Eye Burns; Humans; Male; Ophthalmic Solutions

To compare the outcomes of conventional medical treatment vs combined medical treatment and amniotic membrane transplantation (AMT) in the management of patients with Roper-Hall grade IV ocular chemical injury.. Randomized, parallel-controlled clinical trial.. Setting: Single tertiary referral hospital.. Sixty eyes of 60 patients with Roper-Hall grade IV ocular chemical injury with a minimum follow-up of 12 months were enrolled in the study.. Patients were randomly assigned to 2 groups: Group 1 (30 eyes) received topical preservative-free lubricating gel and drops, chloramphenicol, betamethasone, homatropine, oral vitamin C, and doxycycline; Group 2 (30 eyes) received amniotic membrane transplant (AMT) on the entire ocular surface in addition to the medical treatment provided in Group 1.. The main outcome measure was time to complete corneal epithelialization. Secondary outcome measures were best-corrected visual acuity (BCVA) and neovascularization in the central 5 mm of the cornea.. Mean follow-up time was 20.3 ± 2.5 months (range 13-24 months). Corneal epithelial defects healed within 72.6 ± 30.4 (21-180) days in Group 1 vs 75.8 ± 29.8 (46-170) days in Group 2 (P = .610). Mean BCVA was 2.06 ± 0.67 (0.4-2.6) logMAR vs 2.06 ± 0.57 (1-2.9) logMAR in Groups 1 and 2, respectively (P = .85). Group 1 developed more central corneal neovascularization (22 eyes; 73.3%) compared to Group 2 (16 eyes; 53.3%); however, it was not statistically significant (P = .108).. In comparison to conventional medical therapy, combined amniotic membrane transplantation and medical therapy does not accelerate corneal epithelialization or affect final visual acuity in severe chemical injuries.

Topics: Administration, Ophthalmic; Adolescent; Adult; Amnion; Anti-Bacterial Agents; Ascorbic Acid; Burns, Chemical; Child; Corneal Diseases; Epithelium, Corneal; Eye Burns; Female; Glucocorticoids; Humans; Lubricant Eye Drops; Male; Middle Aged; Ophthalmic Solutions; Prospective Studies; Re-Epithelialization; Visual Acuity; Wound Healing; Young Adult

To evaluate the role of amniotic membrane transplantation (AMT) in acute ocular burns.. Prospective, randomized, controlled clinical trial.. Patients with grade II to IV ocular burns within 3 weeks of injury were recruited. Thirty-seven patients, 7 of whom had bilateral involvement (total, 44 eyes), participated in the trial. Twenty eyes were included in group A (AMT) and 24 eyes were included in group B (controls).. The eyes in the AMT group underwent AMT in addition to conventional medical therapy. In the control group, only conventional medical therapy was instituted.. The patients' subjective assessments of relief of ocular discomfort, healing of the corneal epithelial defect, visual acuity, extent of corneal vascularization, formation of symblepharon, and tear function tests.. At day 1, subjective ocular discomfort scores were reduced significantly in eyes with moderate burns in the AMT group compared with controls (P = 0.05), but there was no difference between the 2 groups in eyes with severe burns. The log mean percentage reduction in size of epithelial defect by day 7 was 7.43+/-0.89 after AMT and 6.23+/-1.10 with medical treatment alone in moderate grade burns at day 7 (P = 0.01), but there was no difference between the 2 groups in eyes with severe burns. There was no overall difference in the final visual acuity, symblepharon formation, corneal vascularization, and tear function tests between the 2 groups over the next 3 months and further follow-up. There was a high dropout rate for long-term follow-up.. Amniotic membrane transplantation in eyes with acute ocular burns has advantages in terms of reduction of pain and promotion of early epithelialization in patients with moderate grade burns, but not so in severe burns. There seems to be no definite advantage to AMT over medical therapy alone in terms of improvement in visual acuity, appearance of symblepharon, corneal vascularization, and results of tear function tests on short-term follow-up.

Topics: Acute Disease; Adolescent; Adult; Amnion; Anti-Bacterial Agents; Ascorbic Acid; Burns, Chemical; Citrates; Combined Modality Therapy; Cornea; Corneal Diseases; Drug Therapy, Combination; Eye Burns; Female; Glucocorticoids; Humans; Male; Ophthalmic Solutions; Prospective Studies; Sodium Citrate; Tears; Tropanes; Wound Healing

Topics: Adrenal Cortex Hormones; Adult; Animals; Ascorbic Acid; Burns, Chemical; Citrates; Citric Acid; Clinical Trials as Topic; Conjunctiva; Corneal Injuries; Corneal Transplantation; Eye Burns; Guinea Pigs; Humans; Male; Middle Aged; Random Allocation

This overview of the biochemical and pathophysiologic events after chemical burns of the eye is intended to act as a guide for appropriate therapy. Effective emergency measures must be instituted immediately followed by careful clinical evaluation to recognize and then treat problems at their inception. When and how to use the variety of drugs and devices is detailed. When these new methods and technology are applied successfully the clinical course may be improved and visual rehabilitation secured. The early results of conjunctival transplantation and hormonal therapy offer promise from experimental procedures. Exciting new treatments employing the foodstuffs ascorbate or citrate (orthomolecular therapy) are currently under investigation. The National Eye Institute sponsors our ongoing randomized clinical trial of these compounds in the treatment of the alkali burned eye. The outcome may change our thinking and our expectations after chemical burns of the eye.

Topics: Ascorbic Acid; Burns, Chemical; Citrates; Citric Acid; Emergency Medical Services; Eye Burns; Hormones; Humans

Topics: Alkalies; Ascorbic Acid; Burns, Chemical; Citrates; Clinical Trials as Topic; Eye Burns; First Aid; Humans; Nandrolone; Progesterone

Children are at high risk of injuries and wounds. The application of medical grade honey is a promising approach to improving the healing of wounds of various origin and severity. However, the use of medical grade honey in young paediatric patients remains limited. The aim of this study is to show the safety, efficacy and usefulness of medical grade honey in abdominal wounds, of different causes, in paediatric patients.. This was a prospective, observational case series evaluating five young infants with abdominal wounds at the General Hospital in Thessaloniki. All wounds were treated in the same manner with daily medical grade honey applied to the wound area and closely monitored.. All treated wounds rapidly presented granulation tissue formation and underwent re-epithelialisation. Peripheral oedema and inflammation decreased upon initial application. Necrotic tissue was effectively debrided when present. Slough was removed and no signs of infection were detected, irrespective of initial wound presentations. Scar formation was minimal and the full range of motion was preserved in all cases.. Based on this case study, medical grade honey is safe and effective in treating different abdominal wounds, including infected or dehisced wounds as well as burns. The easy application and broad applicability make medical grade honey recommendable as a first-line treatment in paediatric patients.

Topics: Abdominal Injuries; Apitherapy; Appendectomy; Appendicitis; Ascorbic Acid; Bacteroides Infections; Burns; Burns, Chemical; Child; Child, Preschool; Dermatologic Agents; Drug Resistance, Multiple, Bacterial; Edema; Female; Gastrostomy; Greece; Honey; Humans; Infant; Infant, Newborn; Inflammation; Klebsiella Infections; Lanolin; Male; Neuroblastoma; Oils, Volatile; Ointments; Prospective Studies; Re-Epithelialization; Retroperitoneal Neoplasms; Surgical Wound Dehiscence; Surgical Wound Infection; Vitamin E; Vitamins; Zinc Oxide

To offer an ideal hospitable environment for corneal keratocyte growth, the carrier materials can be functionalized with incorporation of signaling molecules to regulate cell biological events. This study reports, for the first time, the development of gelatin/ascorbic acid (AA) cryogels for keratocyte carriers in vitro and in vivo. The cryogel samples were fabricated by blending of gelatin with varying amounts of AA (0-300 mg) and carbodiimide cross-linking via cryogelation technique. Hydrophilic AA content in the carriers was found to significantly affect cross-linking degree and pore dimension of cryogels, thereby dictating their mechanical and biological stability and AA release profile. The cryogel carriers with low-to-moderate AA loadings were well tolerated by rabbit keratocyte cultures and anterior segment eye tissues, demonstrating good ocular biocompatibility. Although higher incorporated AA level contributed to enhanced metabolic activity and biosynthetic capacity of keratocytes grown on cryogel matrices, the presence of excessive amounts of AA molecules could lead to toxic effect and limit cell proliferation and matrix production. The cytoprotective activity against oxidative stress was shown to be strongly dependent on AA release, which further determined cell culture performance and tissue reconstruction efficiency. With the optimum AA content in carrier materials, intrastromally implanted cell/cryogel constructs exhibited better capability to enhance tissue matrix regeneration and transparency maintenance as well as to mitigate corneal damage in an alkali burn-induced animal model. It is concluded that understanding of antioxidant molecule-mediated structure-property-function interrelationships in gelatin/AA cryogels is critical to designing carrier materials for potential use in corneal stromal tissue engineering.. Multifunctional cryogel material can offer an ideal hospitable environment for cell-mediated tissue reconstruction. To our knowledge, this is the first report describing the use of gelatin/ascorbic acid (AA) cryogels as keratocyte carriers for corneal stromal tissue engineering. The AA loading during cryogel fabrication is found to have a significant effect on cross-linking degree and pore dimension, mechanical and biological stability, ocular biocompatibility, cell culture performance, and cytoprotective activity, giving comprehensive insight into fine-tuning the structure-property-function interrelationships of keratocyte carrier material. Using an alkali burn-induced animal model, we present evidence that with the optimum AA loading into cryogel materials, intrastromally implanted cell/carrier constructs exhibited better capability to enhance tissue matrix regeneration and transparency maintenance as well as to mitigate corneal damage.

Topics: Animals; Ascorbic Acid; Biocompatible Materials; Burns, Chemical; Cell Proliferation; Cells, Cultured; Corneal Injuries; Corneal Keratocytes; Corneal Stroma; Cryogels; Gelatin; Hydrophobic and Hydrophilic Interactions; Male; Microscopy, Electron, Scanning; Models, Animal; Oxidative Stress; Rabbits; Regeneration; Tissue Engineering

Topics: Administration, Topical; Aged; Ascorbic Acid; Burns, Chemical; Eye; Eye Burns; Humans; Male

The incidence of accidental and intentional acid skin burns is rising. Current treatment strategies are mostly inadequate, leaving victims disfigured and without treatment options. Here, we have shown that transplantation of adipose-derived stem cells (ASCs) accelerates the process of acid burn wound-healing. Pre-conditioning of ASCs using ascorbic acid (AA) or hypoxic conditions provided additional benefit. While the wounds were ultimately healed in all mice, histological analysis revealed that, in non-transplanted animals, the number of hair follicles was reduced. Bioluminescent imaging (BLI) of transplanted ASCs revealed a gradual loss of transplanted cells, with a similar rate of cell death for each treatment group. The signal of fluorinated cells detected by a clinically applicable

Topics: Acids; Adipocytes; Animals; Ascorbic Acid; Burns, Chemical; Cell Hypoxia; Cell Survival; Cells, Cultured; Disease Models, Animal; Fluorine-19 Magnetic Resonance Imaging; Humans; Luminescent Measurements; Male; Mice; Multimodal Imaging; Skin Diseases; Stem Cell Transplantation; Treatment Outcome; Wound Healing

A 40-years-old female patient was referred to the cornea clinic as a probable case of bilateral keratitis. The patient had a history of headache followed by acute onset of redness, pain and discharge from both eyes for 15 days. The patient was diagnosed as bilateral keratitis by the first contact physician and was started on topical antibiotics, cycloplegics and lubricating eye-drops. At presentation, both eyes had visual acuity of perception of light, conjunctival congestion, limbal blanching, diffuse corneal oedema and epithelial defect. A detailed history revealed application of Vicks VapoRub [topical ayurvedic analgesic which contains (per 100 g of product) menthol (2.82 g), camphor (5.25 g) and eucalyptol (1.49 mL) and excipients include thymol (0.1 g), turpentine oil (5.57 mL), nutmeg oil (0.54 mL), cedar wood oil and petrolatum)] on the forehead and eyelids for headache several times over 2-3 days before the onset. The patient further confirmed the accidental application of the ointment in the eyes. A provisional diagnosis of acute chemical injury with Vicks VapoRub was made and treatment with topical antibiotic, cycloplegic, steroid, lubricant and vitamin C was started. On follow-up, both eyes showed gradual resolution of corneal oedema and epithelial defect. Visual acuity improved in the left eye to 6/60 with no change in right eye due to corneal haze.

Topics: Acute Disease; Administration, Topical; Adult; Anti-Bacterial Agents; Ascorbic Acid; Burns, Chemical; Corneal Edema; Diagnosis, Differential; Female; Headache; Humans; Keratitis; Lubricant Eye Drops; Medicine, Ayurvedic; Mydriatics; Steroids; Treatment Outcome; Visual Acuity

Topics: Accidents, Traffic; Aged; Air Bags; Anti-Bacterial Agents; Antioxidants; Ascorbic Acid; Burns, Chemical; Chloramphenicol; Conjunctiva; Conjunctivitis; Corneal Edema; Eye Burns; Female; Glucocorticoids; Humans; Lubricants; Male; Ophthalmic Solutions; Prednisolone; Sodium Hydroxide

Topics: Anti-Bacterial Agents; Antioxidants; Ascorbic Acid; Burns, Chemical; Drug Therapy, Combination; Eye Burns; Humans; Male; Middle Aged; Ophthalmic Solutions; Plant Extracts; Tear Gases; Tetracycline; Treatment Outcome

To report the long-term sequelae of a case of bilateral chemical keratitis caused by airbag deployment.. Case report and review of the literature.. A 21-year-old woman presented with bilateral reduced vision, photophobia, and tearing after a car accident. Examination revealed some facial burns and severe chemical injury to the cornea and conjunctiva. Immediate irrigation with physiologic saline solution and subsequent treatment with topical antibiotics, corticosteroids, and vitamin C resulted in full restoration of vision but could not prevent permanent corneal damage.. Severe alkali injury of the cornea generally has a good prognosis but can lead to permanent damage and persistent complaints of dry eye.

Topics: Accidents, Traffic; Adult; Air Bags; Anti-Bacterial Agents; Ascorbic Acid; Burns, Chemical; Corneal Injuries; Drug Therapy, Combination; Eye Burns; Female; Follow-Up Studies; Glucocorticoids; Humans; Keratitis; Photophobia; Therapeutic Irrigation; Vision Disorders; Wounds, Nonpenetrating

Topics: Administration, Topical; Adult; Alkalies; Amnion; Ascorbic Acid; Burns, Chemical; Conjunctiva; Corneal Injuries; Drug Therapy, Combination; Eye Burns; Humans; Male; Tetracyclines; Treatment Outcome

To investigate the efficacy of antioxidant therapy on collagen synthesis in corrosive esophageal burns, 110 Sprague-Dawley rats were divided into five groups of 22 animals each. A standard esophageal caustic burn was produced by 1 ml of 10% sodium hydroxide solution for the rats in groups B to E; group A was instilled only with 0.9% saline after preparation of the distal esophageal segment. Group A animals (controls) were uninjured and untreated. Group B had untreated esophageal burns. Esophageal burns were treated in group C with vitamin E (10 mg/kg IM), in group D with vitamin C (10 mg/kg IP), and in group E with methylprednisolone (30 mg/kg IM) on each of 5 days. Eight rats from each group were killed 4 days after initiation of the study and the abdominal esophagus was studied for tissue malondialdehyde (MDA; micromol/g protein) levels. The other rats were killed 28 days after initiation of the study and determination of hydroxyproline (HP) (microg/g tissue) levels in esophageal tissue was performed for 8 rats in each group. Histopathologic evaluation was also performed in the other 6 rats from each group. MDA levels in esophageal tissue were significantly lower in groups C (9.24 +/- 2.62, P < 0.01) and group E (6.26 +/- 2.22, P < 0.001) than in group B (12.35 +/- 1.80). HP levels were significantly lower in groups A (0.75 +/- 0.21, P < 0.001), C (1.11 +/- 0.15, P < 0.01), and E (0.96 +/- 0.15, P < 0.001) than in group B (1.40 +/- 0.20). Histopathologically, collagen deposition in the submucosa and tunica muscularis was lower in groups C and E than in group B (P < 0.05, and 0.01, respectively). Our results demonstrate that treatment with antioxidant drugs such as vitamin E and methylprednisolone decreased tissue HP levels, and thus inhibited new collagen synthesis and stricture formation in rats with alkali-induced caustic esophageal burns.

Topics: Analysis of Variance; Animals; Anti-Inflammatory Agents; Antioxidants; Ascorbic Acid; Burns, Chemical; Collagen; Disease Models, Animal; Esophagus; Malondialdehyde; Methylprednisolone; Rats; Rats, Sprague-Dawley; Sodium Hydroxide; Statistics, Nonparametric; Vitamin E

To investigate immediate changes in water-soluble metabolites of ocular tissue in alkali-burned eyes by using high-resolution 1H-NMR spectroscopy.. Adult New Zealand rabbit eyes were burned with 1 M NaOH for 1 min. Normal eyes were used as control. Samples from aqueous humor and perchloric acid extracts of the cornea and lens were analyzed on a NMR spectrometer operating at 500 MHz for protons. Metabolites were quantified by comparing peak area with an added internal standard, TSP (3'-trimethylsilylpropinate-2,2,3,3-d4).. Alkali burn of corneal surface causes immediate changes in concentration of many water-soluble metabolites in the anterior segment. Even as far away as the lens a significant increase in lactate was found. Cornea showed a significant increase in glucose and a significant decrease in hypo-taurine concentration. Most changes were observed in aqueous humor, with significant increases in succinate, creatine, scyllo- and myo-inositol and a significant decrease in citrate concentration. Furthermore, a small decrease in ascorbate concentration in aqueous humor was observed.. The present study provides a valuable contribution to the knowledge of metabolic alterations in alkali-burned eyes. It shows that 1H-NMR spectroscopy is well suited for simultaneous qualitative and quantitative analysis of changes of metabolite concentrations in damaged tissues. This can help us to better evaluate and understand the biological alterations due to alkali burn.

Topics: Amino Acids; Animals; Aqueous Humor; Ascorbic Acid; Biomarkers; Burns, Chemical; Carbohydrate Metabolism; Cornea; Eye Burns; Lens, Crystalline; Nuclear Magnetic Resonance, Biomolecular; Nucleotides; Rabbits; Sodium Hydroxide; Solubility

Topics: Ascorbic Acid; Burns, Chemical; Eye Burns; Humans; Hydrogen-Ion Concentration

To review the spectrum of patients with alkali burns admitted over an 11-year period and to assess the clinical outcomes after the introduction of a standard alkali burn treatment protocol.. Retrospective nonrandomized comparative study.. A total of 121 patient records with alkali burns (n = 177 eyes) admitted to a tertiary hospital between 1987 and 1998 were reviewed. Eyes treated with a standard alkali burn treatment protocol, which included intensive topical steroids, ascorbate, citrate, and antibiotics, were compared with eyes treated by conservative management with antibiotics, and a short course of steroids.. Time to corneal reepithelialization, final best-corrected visual acuity, and time to visual recovery, length of hospital stay, and complications were analyzed.. The standard protocol tended to delay corneal reepithelialization by one day (P: = not significant) in eyes with grade 1 burns (n = 76) and by 2 days (P: = 0.04) in grade 2 burns (n = 52), with no difference in final visual outcome. There were 37 eyes with grade 3 burns. Those treated with the standard protocol showed a trend toward more rapid corneal reepithelialization. Twenty-seven of 29 (93%) eyes with grade 3 injuries achieved a final best-corrected visual acuity of 20/40 or better compared with 3 of 6 (50%) eyes not treated according to the standard protocol (P: = 0.02). Eyes with grade 4 burns (n = 12), whether treated with the standard protocol or not, required 10 to 12 weeks for corneal reepithelialization. There was no statistically significant difference in final visual acuity.. On the basis of our findings, a number of recommendations can be made for the management of alkali injuries. Patients with a grade 1 or 2 injury do not require routine admission and do not benefit from the use of intensive treatment with ascorbate and citrate. A trend toward more rapid healing and a better final visual outcome were apparent in grade 3 burns, but our standard protocol made no difference in grade 4 burns.

Topics: Administration, Topical; Adult; Alkalies; Anti-Bacterial Agents; Anti-Inflammatory Agents; Ascorbic Acid; Burns, Chemical; Citric Acid; Drug Therapy, Combination; Epithelium, Corneal; Eye Burns; Female; Glucocorticoids; Hospitals, Special; Humans; Male; New South Wales; Ophthalmic Solutions; Ophthalmology; Retrospective Studies; Treatment Outcome; Wound Healing

The effects of topical dexamethasone on the endothelial healing and the change of aqueous compositions were investigated during the repair process of alkali-wounded rabbit cornea.. A central corneal alkali wound was produced by a 60 sec application of a 5.5 mm round filter paper soaked in 1N NaOH onto one eye of each rabbit. The eyes subsequently were treated topically with either 0.1% dexamethasone or a balanced salt solution (BSS) 4 times per day for 8 weeks. Endothelial wound morphometry was performed after alizarin red and trypan blue staining. The concentrations of ascorbic acid, glucose, and the ions, Na+, K+, Ca2+ and Mg2+, were measured in the aqueous humor.. Endothelial healing in control (alkali-wounded but not treated with dexamethasone) corneas showed a biphasic pattern of healing: an initial short-term healing for the first week and then a late long-term healing following the secondary endothelial breakdown. Topical administration of 0.1% dexamethasone deterred endothelial healing during the early period and prevented the secondary endothelial breakdown. However, the total repair process of endothelium was accelerated by the dexamethasone-treatment. Among the various components of the aqueous humor examined, ascorbic acid seemed the most sensitive to change caused by the alkali injury and dexamethasone treatment.. The present data indicate that dexamethasone may have a therapeutic potential in the management of endothelial healing after corneal alkali injury.

Topics: Administration, Topical; Animals; Aqueous Humor; Ascorbic Acid; Burns, Chemical; Cations; Dexamethasone; Endothelium, Corneal; Eye Burns; Glucose; Ophthalmic Solutions; Rabbits; Sodium Hydroxide; Wound Healing

Topics: Ascorbic Acid; Burns, Chemical; Emergency Treatment; Eye Burns; Humans; Male; Middle Aged; Potassium Permanganate; Therapeutic Irrigation

Xylene is a hydrocarbon solvent found in various industrial preparations such as paint and is widely used in pathology laboratories. When inadvertently instilled into the eye significant ocular injury can occur with the potential for blindness. Such injuries to the ocular surface resemble those due to alkali. Ocular surface injury due to xylene has not been reported previously in the literature. We strongly recommend that these injuries be treated as emergencies in a similar way to alkali burns in the Eye department since the chemical mixture of which xylene forms a part may be alkaline. Such an approach is vital in order to save sight.

Topics: Accidents, Occupational; Adult; Anti-Bacterial Agents; Anti-Inflammatory Agents; Ascorbic Acid; Burns, Chemical; Chloramphenicol; Cyclopentolate; Dexamethasone; Eye Burns; Humans; Male; Mydriatics; Occupational Diseases; Paint; Xylenes

Ocular alkali burns can be associated with a poor visual outcome. The release of collagenases and proteases after the injury leads to corneoscleral melting. The role of topical steroids in such patients is controversial as they have been postulated to exacerbate corneoscleral melting.. 30 patients were reviewed retrospectively after admission to King's College Hospital with alkali burns between 1990 and 1993. All patients were treated with an intense and prolonged regimen of topical steroids and topical and systemic vitamin C.. 22 patients had mild injuries and eight had severe injuries as estimated by the Roper-Hall grading system. 23 patients were treated with topical steroids for > 10 days and 22 patients were treated with topical vitamin C for more than 10 days. One patient with a severe injury developed corneoscleral melting.. Prolonged treatment with topical steroids when used in conjunction with topical vitamin C is not associated with corneoscleral melting.

Topics: Administration, Topical; Adolescent; Adult; Aged; Alkalies; Anti-Inflammatory Agents; Ascorbic Acid; Burns, Chemical; Drug Therapy, Combination; Eye Burns; Female; Humans; Male; Middle Aged; Prednisolone; Retrospective Studies; Treatment Outcome

We examined the effect of L-ascorbic acid 2-phosphate (P-Asc) on the healing of alkali-burned corneas in rabbits. Round filter paper containing 1 N NaOH was applied to the central cornea for 60 or 120 s to produce the alkali burn. Animals were treated with topical saline, 10% ascorbate, or 6.5% P-Asc applied on the cornea. The corneas were then examined histologically. Burned stroma showed no toluidine blue staining, indicating a loss of glycosaminoglycan. In the 60-s burn group, P-Asc reduced the size of the unstained area as compared with the control. Transmission electron microscopy showed basal lamina under new epithelia in the corneas treated with ascorbate or P-Asc, but not in controls. These observations support the theory that P-Asc may have a therapeutic role in the repair of corneal alkali burns.

Topics: Administration, Topical; Animals; Ascorbic Acid; Basement Membrane; Burns, Chemical; Cornea; Corneal Injuries; Corneal Stroma; Eye Burns; Female; Male; Ophthalmic Solutions; Rabbits; Sodium Hydroxide; Wound Healing

In this report, we aimed at examining biochemically the ocular surface damage caused by alkali burn. We used a low concentration of NaOH (less than 0.1 N) and examined the relationship between the ocular surface damage and the concentration of NaOH by examining the changes in components that have been released from corneoconjunctival tissues to the tear fluids by alkali burns, and we also examined the effects of eye rinsing and using topical ophthalmic agents. As a result, NaOH of more than 0.03 N was proven to cause the ocular surface damage. The changes of glutathione in tear fluids showed two peaks during the repair process and that coincided with the morphological changes. By measuring the released quantities of three components (glutathione, ascorbic acid and protein) with the use of three methods of alkali burns (corneoconjunctival pooling method, corneal cylinder method and conjunctival pooling method), we could estimate the slight corneoconjunctival damage using one sample biochemically. Moreover, the importance of eye rinsing was quantitatively demonstrated.

Topics: Alkalies; Animals; Aqueous Humor; Ascorbic Acid; Burns, Chemical; Eye Burns; Eye Proteins; Glutathione; Male; Rabbits; Sodium Hydroxide; Tears

The incidence of ulceration and perforation in the cornea of alkali-injured eyes is significantly reduced by treatment with trisodium citrate or sodium ascorbate. Topical citrate reduces the inflammatory response in the cornea by inhibiting polymorphonuclear leukocytes. Topical ascorbate elevates the depressed level of this vitamin in the alkali-injured cornea, reversing a scorbutic condition. The purpose of the current study was to determine whether combined treatment with topical citrate and ascorbate has an additional therapeutic value when compared with citrate alone. Adsorbotear without EDTA was used as the vehicle for both medications. Rabbit eyes were injured with 1N NaOH for 35 s using a 12-mm well and were rinsed. Group I (47 eyes) received two drops of 10% citrate every hour on the hour and Adsorbotear on the half-hour for 14 h/day. Group II (48 eyes) received two drops of 10% citrate every hour on the hour and 10% ascorbate every hour on the half-hour for 14 h/day. The citrate/ascorbate group had significantly fewer ulcerations during the experiment than did the group receiving citrate alone (2 of 48 versus 10 of 47, 0.01 less than p less than 0.02). Both anterior ulcers in the citrate/ascorbate group and five ulcers in the citrate group healed to no ulcer by the end of the experiment (0 of 48 versus 5 of 47, 0.02 less than p less than 0.05). The average depth of ulceration was significantly less for the citrate/ascorbate group (p less than 0.001). No descemetoceles or perforations were observed in either group.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Alkalies; Animals; Antacids; Ascorbic Acid; Burns, Chemical; Citrates; Citric Acid; Corneal Ulcer; Disease Models, Animal; Drug Combinations; Eye Burns; Rabbits

Immediate treatment of alkali-injured eyes with citrate or ascorbate has previously been shown to prevent corneal ulceration and perforation in the rabbit. Other experiments showed that while ascorbate treatment of established ulcers did not appear to lead to significant healing it did reduce perforations by prolonging the presence of descemetoceles. In the present experiment with established ulcers, alkali injuries were created with 1 N NaOH in a 12 mm corneal well for 35 seconds. Eyes were entered into the study with anterior, middle or posterior ulcers. When compared to controls, 10% citrate (q1/2 hr) significantly reduced the deepening of anterior stromal ulcers while 10% ascorbate/10% citrate (q1 hr/q1 hr-30 min apart) showed only a trend toward reduction of these ulcers (14 hr of dropping). The demonstration of healing (total vascularization or no ulcer) is significant when comparing the control group (8.3%) to the citrate treated group (58.3%, 0.01 less than P less than 0.009), but not the ascorbate/citrate group (18.2%). Sixty-seven percent of anterior stromal ulcers in the control group progressed to descemetocele or perforation, compared to 8.3% in the citrate treated (0.003 less than P less than 0.004), and 45.5% in the ascorbate/citrate treated group (not significant). While the numbers of ulcers entered as middle stromal were too few to analyze statistically, the reduced numbers of perforations and increased stability prior to perforation in both treatment groups suggest a positive effect by both citrate and ascorbate/citrate. Treatment of posterior stromal ulcers did not prevent the development of descemetoceles and perforations in either treatment group; however, the numbers in this category were too few to analyze.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Animals; Ascorbic Acid; Burns, Chemical; Citrates; Citric Acid; Corneal Ulcer; Drug Therapy, Combination; Eye Burns; Female; Male; Osmolar Concentration; Rabbits; Sodium Hydroxide; Solutions

Topics: Alkalies; Animals; Aqueous Humor; Ascorbic Acid; Burns, Chemical; Carbon Dioxide; Conjunctiva; Corneal Injuries; Hydrogen-Ion Concentration; Oxygen Consumption; Rabbits

Alkali-burned corneas were treated with 2% ascorbic acid. Topical applications and subconjunctival injections were given for 32 days. Treatment with ascorbic acid significantly decreases the incidence of corneal ulcerations and perforations compared to the control group that received the vehicle. These results confirm previous studies and strongly suggest that ascorbic acid presents a potential for use in the alkali-burned human eye.

Topics: Animals; Ascorbic Acid; Burns, Chemical; Corneal Ulcer; Eye Burns; Rabbits; Sodium Hydroxide

Topics: Alkalies; Ascorbic Acid; Burns, Chemical; Corneal Transplantation; Eye Injuries; Heparin; Humans

Topics: Ascorbic Acid; Burns, Chemical; Chemical Phenomena; Chemistry; Conjunctiva; Corneal Injuries; Eye Burns; Female; Humans; Infant, Newborn; Potassium Permanganate

Chemical injury of the eye may occur in a wide range of circumstances. Of first importance is the recognition of the nature of the injury since an increasing number of toxic substances is being used in home and industry and each type of compound may produce unusual corneal and conjunctival changes. Early assessment of the severity of the corneal burn helps determine prognosis and directs treatment. The use of topical sodium ascorbate and citrate has added new prospects of reduced corneal damage while enzyme inhibitors have shown some value in preventing and controlling corneal melting. The later problems of recurrent or persistent epithelial defects require careful manipulation of the tear film and corneal environment including the use of therapeutic soft contact lenses. In the long term, attention to the whole corneal environment, especially lids, conjunctiva, and tears, becomes most important especially in selection of patients for keratoplasty and in management of the complications which may follow surgery.

Topics: Alkalies; Ascorbic Acid; Burns, Chemical; Citrates; Enzyme Inhibitors; Eye Burns; Humans

When established corneal ulcers induced by alkali burning were treated with 10% ascorbate drops, no perforation occurred, in contrast to a 25% incidence in the control group. If perforations and descemetoceles were grouped together, these difference became insignificant (i.e., 14.2% ascorbate-treated vs. 25% control). Prolongation of descemetocele presence without perforation in the ascorbate-treated group indicated some therapeutic effect. We conclude that topical ascorbate does not substantially alter the outcome of established corneal ulcers.

Topics: Administration, Topical; Alkalies; Animals; Ascorbic Acid; Burns, Chemical; Corneal Ulcer; Eye Burns; Rabbits

Between 6 and 16 days after mild alkali burns of rabbit eyes, the aqueous humor and corneal stroma ascorbic acid levels were decreased in the untreated animals. Systemic treatment with ascorbate 0.5 g/kg body weight injected daily subcutaneously) raised the reduced ascorbic acid levels to twice the normal values in the aqueous humor, but those of the corneal stroma increased only slightly and remained far below the normal levels. The systemic ascorbate treatment did not improve the healing rate of the corneal epithelium, but increased adenosine triphosphate and diphosphate levels as well as the ATP/ADP ratio of the glutathione was shifted to a more reduced state.

Topics: Alkalies; Animals; Aqueous Humor; Ascorbic Acid; Burns, Chemical; Cornea; Eye Burns; Injections, Subcutaneous; Rabbits; Wound Healing

Experimental and clinical observations suggested that after alkali burns of the eyes, neutralization of the tissues and the aqueous humor occurred with in hours. The further course of the disease was found to be an inflammatory reaction. Consequently, an anti-inflammatory therapy was introduced and employed with success in experiments and in the clinics.

Topics: Adrenal Cortex Hormones; Ascorbic Acid; Burns, Chemical; Eye Burns; Humans; Medroxyprogesterone

To test the hypothesis that superoxide radicals are involved in tissue destruction after alkali burns, superoxide dismutase, ascorbic acid, and glutathione were used as superoxide radical scavenging agents. Daily subconjunctival injections were given in rabbit eyes after alkali burns. Both superoxide dismutase and ascorbic acid were effective in preventing corneal perforations. Glutathione did not show any beneficial effect. These experiments suggest that superoxide radical scavenging agents may be useful in the treatment of ocular alkali burns.

Topics: Alkalies; Animals; Ascorbic Acid; Burns, Chemical; Disease Models, Animal; Eye Burns; Glutathione; Rabbits; Superoxide Dismutase

Rabbits receiving subcutaneous ascorbate after corneal wounding showed significant elevation of aqueous humor ascorbate levels but no enhancement of wound breaking strength when compared to controls. In a second group of rabbits, perilimbal alkali burning reduced aqueous humor ascorbate levels one-half to one-third normal. In these perilimbally burned eyes with wounds in clear cornea, subcutaneous ascorbate significantly raised the aqueous humor ascorbate level and enhanced breaking wound strength compared to controls. We conclude that parenterally administered ascorbate has no salutory effect on the breaking strength of corneal wounds in the normal rabbit eye. In contrast, subcutaneous ascorbate has a very favorable effect on the breaking strengths of corneal wounds in those eye with depressed aqueous humor ascorbate.

Topics: Alkalies; Animals; Aqueous Humor; Ascorbic Acid; Burns, Chemical; Corneal Injuries; Eye Burns; Injections, Subcutaneous; Rabbits; Wound Healing

Alkali-burned eyes (45 sec, 12 mm, 4N NaOH) were subjected to topical treatment with 10% ascorbate, 20% acetylcysteine, 10% ascorbate together with 20% acetylcysteine, 10% citrate, or Adsorbotear vehicle. Only citrate-treated eyes showed a significant decrease in corneal ulcerations and perforations (17%) compared with ascorbate (88%), acetylcysteine (81%), ascorbate/acetyl-cysteine (100%), or Adsorbotear (75%). In the citrate-treated eyes there was a significantly reduced incidence of band keratopathy (17%) but an increased incidence of hyphema (100%). Both groups receiving acetylcysteine developed acellular corneal caps, the result of peripheral ulceration undermining the central cornea. Polymorphonuclear neutrophils (PMN) were substantially increased at the base of the cap in the acetylcysteine- and acetylcysteine/ascorbate-treated eyes at day 56. At the end of the experiment, citrate-treated eyes showed substantially fewer stromal PMN than any other group. These results show that topical citrate has a most favorable effect on the incidence of corneal ulceration and perforation after alkali burning.

Topics: Acetylcysteine; Administration, Topical; Alkalies; Animals; Ascorbic Acid; Burns, Chemical; Citrates; Citric Acid; Corneal Ulcer; Eye Burns; Rabbits

Severe ocular alkali burns in rabbits result in a decrease in aqueous humor ascorbate levels to one-third normal levels. If this deficiency is reversed by immediate treatment with parenteral or topical ascorbate, there is a significantly decreased incidence of subsequent corneal ulceration and perforation. The morphologic changes in these ulcerating corneas are typical of those noted in scorbutus (scurvy). It is concluded that alkali injury to the ciliary epithelial transport processes or ciliary body vasculature results in localized deficiency of ascorbic acid in the aqueous humor and cornea. The development of corneal ulceration is thought to be based on this deficiency which results in the failure of fibroblasts to produce sufficient collagen for repair. A randomized clinical trial of ascorbic acid in the treatment of human alkali burned eyes is now underway.

Topics: Alkalies; Animals; Aqueous Humor; Ascorbic Acid; Burns, Chemical; Cornea; Corneal Injuries; Corneal Ulcer; Disease Models, Animal; Eye Burns; Rabbits; Scurvy

Topics: Animals; Ascorbic Acid; Burns, Chemical; Cornea; Corneal Injuries; Corneal Ulcer; Eye Burns; Humans; Rabbits; Wound Healing

The corneas of albino rabbits were subjected to 45 sec, 12 mm, 2.3N hydrochloric acid burns. Of 18 eyes in nine rabbits receiving no treatment (controls), 11 (61%) developed ulceration sometimes progressing to descemetoceles and perforation. Of 17 eyes in nine rabbits receiving a daily subcutaneous injection of ascorbic acid (0.5 gm/kg), only one eye (5.9%) developed an anterior stromal ulcer. The difference in incidence of ulceration between the control and ascorbate-treated eyes was statistically significant (p less than 0.01). The aqueous humor level of ascorbate in untreated animals was 6.0 +/- 0.6 mg/dl compared to 33.0 +/- 2.7 in the treated group. This study therefore demonstrates that subcutaneous administration of ascorbic acid significantly raises the aqueous humor level of ascorbic acid in severely acid-burned eyes, thereby largely preventing the characteristic development of corneal ulceration. The mechanism of this effect is presumably the same as previously described for alkali-burned eyes.

Topics: Animals; Aqueous Humor; Ascorbic Acid; Burns, Chemical; Corneal Injuries; Corneal Ulcer; Eye Burns; Female; Hydrochloric Acid; Injections, Subcutaneous; Male; Rabbits

Rabbit eyes were subjected to severe alkali burns (35 sec, 12 mm, 1N sodium hydroxide). In one experiment, rabbits in the treated group received a daily subcutaneous injection of neutralized ascorbic acid solution (0.5 gm/kg body weight), while control animals received no treatment. At the termination of the experiment (30 days), 11 of 16 eyes (68.8%) in the control group had ulcerated or formed descemetoceles, and in the experimental (treated) group, 15 of 20 eyes (75%) had ulcerated, formed descemetoceles, or perforated. In a second experiment, burned rabbits received topical 10% ascorbic acid while control eyes were given the vehicle only. At the termination of the experiment (34 days), 16 of 20 eyes (80%) in the control group had ulcerated or perforated, compared to five of 18 eyes (27.8%) in the ascorbate treated groups. The failure of systemic administration of ascorbic acid to prevent corneal ulceration could be explained on the basis of inadequate penetration of ascorbic acid into the anterior segment of severely burned rabbit eyes. On the other hand, immediate topical treatment of identically burned rabbit eyes achieved greatly elevated aqueous humor ascorbate levels and provided substantial protection from corneal ulceration and perforation.

Topics: Administration, Topical; Alkalies; Animals; Ascorbic Acid; Burns, Chemical; Eye Burns; Injections, Subcutaneous; Rabbits; Tissue Distribution

Topics: Administration, Topical; Alkalies; Animals; Aqueous Humor; Ascorbic Acid; Burns, Chemical; Cornea; Corneal Ulcer; Eye Burns; Female; Pharmaceutical Vehicles; Rabbits

Depressed aqueous humor glucose and ascorbic acid levels returned to control values within 14 days following a 20 sec, 6 mm. diameter, 1N sodium hydroxide burn of the rabbit cornea. These corneas did not ulcerate or perforate. After a 20 sec., 12 mm. diameter, 1N sodium hydroxide burn, aqueous humor glucose levels returned to normal values, but ascorbic acid levels remained significantly depressed for up to 30 days. These corneas became markedly ulcerated in about 60 per cent of animals and frequently perforated. Following 12 mm. alkali burns, rabbits treated daily with 1.5 Gm. of subcutaneous ascorbic acid rarely developed corneal ulcerations and the corneas did not perforate. It is suggested that exogenous maintenance of adequate aqueous humor levels of ascorbic acid overcomes the relatively scorbutic state of the anterior segment induced by a 12 mm. alkali burn, thereby impairing the development of corneal ulceration and perforation. Elevated aqueous humor levels of ascorbic acid had no influence on corneal epithelial cell migration patterns following alkali burns.

Topics: Alkalies; Animals; Aqueous Humor; Ascorbic Acid; Burns, Chemical; Corneal Ulcer; Disease Models, Animal; Eye Burns; Female; Glucose; Male; Rabbits

Topics: Ascorbic Acid; Burns, Chemical; Eye Injuries; Female; Humans; Potassium Permanganate

Topics: Adult; Aged; Ascorbic Acid; Body Surface Area; Burns; Burns, Chemical; Burns, Electric; Germany, West; Humans; Middle Aged; Phosphorus; Rutin; Water-Electrolyte Balance; Wound Infection

Topics: Adolescent; Aged; Alkaloids; Analgesics; Ascorbic Acid; Atropine; Burns, Chemical; Child; Child, Preschool; Esophageal Diseases; Esophagus; Female; Gastric Lavage; Humans; Infant; Male; Penicillins; Plasma Substitutes; Prednisolone; Strophanthins; Thiamine Pyrophosphate; Vitamin B Complex

Topics: Acute Disease; Adrenal Cortex Hormones; Ascorbic Acid; Burns, Chemical; Chronic Disease; Contact Lenses; Cornea; Corneal Injuries; Edema; Eye Diseases; Glaucoma; Glucose; Glycerol; Humans; Hypertonic Solutions; Idoxuridine; Intraocular Pressure; Keratitis, Dendritic; Keratoconus; Ophthalmic Solutions; Povidone; Silicones; Sodium Chloride; Surface-Active Agents; Tears

Topics: Anterior Chamber; Ascorbic Acid; Burns, Chemical; Calcium Hydroxide; Edetic Acid; Eye Burns; Hydrogen-Ion Concentration; Sodium Chloride; Solutions; Tromethamine

Topics: Animals; Ascorbic Acid; Burns, Chemical; Corticosterone; Eye Burns; Humans; Prognosis; Rabbits; Synephrine