OBJECTIVE: To evaluate chronic ocular sequelae in patients with symblepharon caused by ocular burns and propose an objective grading system.
METHODS: This was a retrospective, single-center clinical study. Patients with symblepharon caused by ocular burns at least six months later were assessed. Chronic ocular sequelae were classified into 3 categories (eyelid, conjunctiva, and cornea) and 9 chronic ocular sequelae [friction factors, exposure factors, conjunctival hyperemia, length of symblepharon, scope of adhesion, lacrimal area adhesion, loss of the palisades of Vogt (POV), corneal neovascularization, and corneal opacification]. Each ocular sequela was graded from 0 to 3, depending on the increasing severity. The 9 ocular sequelae were evaluated to obtain the total severity score for each eye. The total severity score was defined as Grade I (1-9), Grade II (10-18), and Grade III (19-27). Moreover, the correlation between the severity of chronic ocular sequelae and visual acuity, surgical strategy, and the prognosis was analyzed, respectively.
RESULTS: Cases of 79 eyes with symblepharon caused by ocular burns were included in this study. Of these, 20 (25.32%) were defined as Grade I, 43 (54.43%) as Grade II, and 16 (20.25%) as Grade III. Eyes with a high total severity score had reduced visual acuity, required complicated surgery strategies, and poor prognosis (P<0.001). Multivariate regression analysis showed that the scope of adhesion, corneal opacification, and corneal neovascularization significantly affected visual acuity, surgical strategy, and prognosis (all P<0.001).
CONCLUSIONS: The evaluation of chronic ocular sequelae enabled the development of an objective grading system for patients with symblepharon caused by ocular burns. This grading system can be applied to guide the treatment and predict the prognosis.

This study aimed to describe the clinical features, surgical management of the eyelid and ocular surface, and outcomes of 16 patients implanted with a Boston type I keratoprosthesis (KPro).
A retrospective, single-center, consecutive case series of 16 patients with Stevens-Johnson syndrome (1), ocular chemical burns (12), and ocular thermal burns (3) implanted with KPro was studied. All subjects were men aged 27-51 years. Surgical treatment and outcomes for eyelid malposition, symblepharon, and glaucoma were assessed.
From September 2010 to February 2019, 29 patients were admitted to Zhongshan Ophthalmic Center for KPro implantation, of whom 16 (55%) required eyelid or ocular surface surgeries to maintain hydration and protect the corneal tissue, which is vulnerable to epithelial defects. Forty-one adnexal surgical procedures were performed. The most common indication for surgery was symblepharon, and the most frequent procedures were symblepharon lysis with ocular mucous membrane grafts and amniotic membranes (7) and full-thickness skin grafts to the eyelids (7). Preoperative conjunctival injection and corneal staining were documented in 9 (56%) and 8 (50%) eyes, respectively, and at up to 4 months postoperative follow-up (the last adnexal surgery before KPro) were recorded in 3 (19%, p = 0.03) and 2 (12%, p = 0.02) eyes, respectively. Glaucoma drainage devices were inserted in six patients. One patient with Stevens-Johnson syndrome underwent FP7 Ahmed glaucoma valve (AGV) implantation inferotemporally and developed plate exposure 2 months postoperatively. Five patients underwent FP8 AGV implantation with tube insertion into the vitreous cavity due to the scarred conjunctiva and limited subconjunctival space. In the study period, intraocular pressure (IOP) was in the normal range, and no tube or plate exposure was observed.
The ocular environment is critical for successful KPro surgery. A multidisciplinary approach for any lid and ocular surface abnormality in ocular burns or Stevens-Johnson syndrome is important to improve the quality of the ocular surface and accommodate KPro and AGV, which is vital for maintaining vision after KPro surgery. FP8 AGV may be feasible for IOP control in adult KPro cases with restricted subconjunctival space.

Objective: To investigate the wave variations of the electroretinography (ERG), and explore the clinical value of using ERG in alkali injury. Methods: A total of 13 patients with alkali burns who were treated in the Department of Ophthalmology of Peking University Third Hospital from May 2018 to October 2019 were selected, including 12 males and 1 female. The age ranged from 19 to 60 years old. A total of 15 injured eyes were used as the alkali burn group, meanwhile, another 15 contralateral eyes with mechanical unilateral trauma were used as the healthy controls. ERG examination was performed to compare the amplitudes of 6 activation-induced responses between the two groups. Results: Compared with control group, b-wave amplitude of dark adaption 0.01 ERG in alkali injury group decreased [(137±23) μV vs (348±14) μV, P<0.001]. Compared with control group [(335±17) μV and (368±19) μV], a-wave amplitude of dark adaption 3.0 ERG and 10.0 ERG in alkali injury groups [(172±20) μV and (220±21) μV] were decreased (both P<0.001). As for b-wave amplitude of dark adaption 3.0 ERG and 10.0 ERG, compared with control group [(610±20) μV and (612±19) μV], those of alkali injury groups [(359±21) μV and (384±21) μV] were decreased (both P<0.001). In terms of oscillatory potentials (OPs) amplitude of dark 3.0 ERG adaption, compared with control group [(209±8) μV], that of alkali injury group [(94±13) μV] was decreased (P<0.001). Compared with normal group [(58±3) μV], a-wave amplitude of light adaption 3.0 ERG in alkali injury group [(40±4) μV] was decreased (P<0.001). As for b-wave amplitude of light adaption 3.0 ERG, compared with control group [(146±6) μV], that of alkali injury group [(90±11) μV] was decreased (P<0.001). In terms of photopic 3.0 flicker 30 Hz of light adaption, compared with control group [(166±10) μV], that of alkali injury group [(93±11) μV] was decreased (P<0.001). Conclusion: Alkali injury can cause ocular surface morphological changes, meanwhile, it leads to the alternations of the visual function.
目的： 研究眼表碱烧伤患者视网膜电图（ERG）波形的振幅变化，并探讨功能学检查ERG在碱烧伤中的临床意义。 方法： 选取2018年5月至2019年10月在北京大学第三医院眼科就诊的碱烧伤患者13例，男12例，女1例，年龄19~60岁，总计伤眼15眼作为碱烧伤组；选择机械性单眼外伤患者的对侧眼15眼作为正常对照组。两组行ERG检查，观察并分析比较碱烧伤组和正常对照组各项反应波幅的变化。 结果： 相对于正常对照组，碱烧伤组暗适应0.01ERG b波振幅[（137±23）μV比（348±14）μV，P<0.001]，暗适应3.0ERG和暗适应10.0ERG a波振幅[（172±20）μV比（335±17）μV；（220±21）μV比（368±19）μV，均P<0.001]，暗适应3.0ERG和暗适应10.0ERG b波振幅[（359±21）μV比（610±20）μV；（384±21）μV比（612±19）μV，均P<0.001]，暗适应3.0ERG振荡电位（OPs）振幅[（94±13）μV比（209±8）μV，P<0.001]均降低。相对于正常对照组，碱烧伤组明适应3.0ERG a波振幅[（40±4）μV比（58±3）μV，P<0.001]，明适应3.0ERG b波振幅[（90±11）μV比（146±6）μV，P<0.001]，明适应3.0闪烁光反应[（93±11）μV比（166±10）μV，P<0.001]均降低。 结论： 碱烧伤除了造成眼表形态学改变，同时也引起眼视功能学的改变。.

OBJECTIVE: To evaluate the efficacy of heparin eye drops in the treatment of paraquat-induced ocular surface injury.
METHODS: In this retrospective study, we included 25 patients (31 eyes) with paraquat-induced ocular surface injury, who attended the Affiliated Hospital of Weifang Medical University between October 2008 and October 2013. The patients were split into two groups according to whether or not received heparin eye drops. The clinical data were compared between the two groups, i.e. clinical histories, results of examinations, treatments and outcomes.
RESULTS: Eleven patients (group A, 15 eyes) received prompt irrigation with 0.9% saline every two hours, 0.1% pranoprofen eye drops four times a day, 20% autologous serum every two hours, recombinant bovine basic fibroblast growth factor eye-gel two times a day, oral vitamin C 2.0 g and prednisone 30 mg daily. Fourteen patients (group B, 16 eyes) received additional treatment with heparin eye drops. Ten eyes in group A and seven eyes in group B developed a pseudomembrane on the ocular surface at significantly different rate (mean ± SD) of 1.20 ± 1.01 and 0.43 ± 0.51, respectively (t = 2.66, p = 0.01). Seven eyes among 10 had a pseudomembrane reoccurred in group A while none had a pseudomembrane reoccurred in group B (Fisher\'s exact test, p = 0.01). No significant differences were seen in the duration of epithelial recovery between the two groups: 15.13 ± 5.13 days in group A and 16.81 ± 5.56 days in group B (t = 0.87, p = 0.39). After the treatment, mild corneal opacity and pannus were observed in five patients of group A and four patients of group B, without any significant difference between the two groups (p = 0.70).
CONCLUSIONS: The paraquat-induced ocular surface injury observed in this case series was characterized by the formation of conjunctival pseudomembrane with good prognosis and mild complications. Heparin eye drops reduce the occurrence, especially the reoccurrence of pseudomembrane. Further studies are warranted.