First-line strategies to treat corneal epithelial defects caused by chemical burns range from artificial tears and bandage contact lenses to keratoplasties and amniotic membrane (AM) transplants, depending on the severity of the injury. Looking at alternative therapies, new research suggests mesenchymal stem cells and nanofiber-reinforced AMs may be viable options to complement clinically proven therapies.

Nanofiber-reinforced AMs—retinoic, acid-improved homogenates of AMs—can offer successful outcomes and easily be incorporated into existing effective treatments, the researchers noted. Mesenchymal stem cells were also found to be useful in treating a wide range of corneal diseases, such as limbal stem cell deficiency. In addition, simple limbal epithelial transplantation, which includes placement of several small pieces of limbal fragments directly on the injured eye, presents a way to minimize the amount of tissue biopsied and the cost of ex vivo cultures of limbal cells.

With further development and determination of safety profiles, it is likely these emerging therapies will ultimately replace keratoplasties and AM transplants, which would eliminate the need for matching donor tissues, the investigators said.

Additionally, most of these newer strategies are administered topically, which could help with patient compliance with treatment. An exception is the hydrogel technology. However, the surgery may be less complex compared with current keratoplasty and AM transplant procedures, as it only involves placement of a hydrogel film over the wounded ocular surface without the need for suturing, the researchers explained.

They noted these alternative treatments were overall effective in healing corneal epithelial defects and possessed anti-inflammatory properties. Other benefits included prevention of corneal neovascularization and restoration of the anatomy and functions of the anterior eye.

“With adequate and timely management of resulting corneal epithelial damage, as well as meticulous control of pathological processes including inflammation and edema within the corneal stroma, the ultimate goal of the treatment regimen is to restore eye histology and functionality, thereby enhancing patient outcomes,” the study authors concluded in their paper. “Newer methods may help achieve such goals and lessen the burden that complications may bring on both health care providers and the patient, yet their safety profiles need to be determined before translation to humans.”

Poon SHL, Wong WHL, Bu Y, et al. A systematic review of emerging therapeutic strategies in the management of chemical injuries of the ocular surface. Eye Contact Lens. 2020;46(6):329-40.