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

Burns & Trauma 2019年第1期7卷 233-247页

作者： Kevin M.Klifto ala elhelali Caresse F.Gurno Stella M.Seal Mohammed Asif C.Scott Hultman Department of Plastic and Reconstructive Surgery The Johns Hopkins University School of MedicineBaltimoreMDUSA The Johns Hopkins University School of Nursing BaltimoreMDUSA Welch Medical Library The Johns Hopkins University School of MedicineBaltimoreMDUSA The Johns Hopkins Burn Center 4940 Eastern AvenueBaltimoreMD 21224USA

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 nonsurgical 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 1.63mm shorter epithelial defect diameters on follow-up,SMD 1.55 mm greater changes in epithelial diameters from baseline,SMD 1.17 mm^(2) smaller epithelial defect areas on follow-up,SMD 1.37 mm^(2) 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 e

关键词： Burns Eyelashes Eyebrows Eye Visual acuity Keratitis Stem cell transplantation Ocular Peri-ocular

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