Improvement Of Roper-Hall Grading System And Evaluation Of Medical Or Surgery Intervention In Severe Acute Chemical And Thermal Burns

Objective:To improve Roper-Hall grading system and evaluate clinical outcomes according to the new system.To discuss proper treatments for severe acute chemical and thermal burns.Methods:A retrospective review of 26 consecutive eyes with severe acute chemical and thermal burns was performed.From June 2007 to December 2008,patients admitted to our department without previous surgery intervention were enrolled.The modified classification including two independent parts:corneal/limbus grading system and conjunctiva/eyelid grading system.Corneal/limbus grading system is based on Roper-Hall classification,but add in the concept of "limbus ischemia depth" which recorded as typeA(including depth gradel -2)and typeB(including depth grade3～4). Depth gradel:part of the involved limbus vessels were blocked.2:all the involved limbus vessel were blocked.3:limbus stromal was damaged,tissue coagulation, appeared gray.4:necrotic tissue with an unsmooth surface,appeared porcelain-white. Conjunctiva/eyelid grading system is based on the injury areas and depth.Records of the conjunctiva injury depth is similar to the limbus' and the eyelid injury depth is classified as skin burn depth(from grade0～4).Injury areas are classified according to anatomical division and accumulative involvement.Initial ocular surface condition judging on the modified grading system,treatment details and complications during follow-ups were recorded and analyzed.Results:①For corneal/limbus grading system:11 eyes of modified gradeⅢA successfully repaired the ocular surface by anti-inflammation medical therapy(steroids) and showed better improvement on visual acuity as well as less neovascular invading.6 eyes of modified gradeⅢB～ⅣA got fair clinical outcomes by medical or surgery treatment.9 eyes of modified gradeⅣB needed surgery intervention to prevent tissue melting and perforation.For conjunctiva /eyelids grading system,those eyes with classification of conjunctiva 4/B and eyelid 4/3～4 present symblepharon.②Medical treatment group included 14 eyes.The mean epithelial healing time was 20.91±15.95 days.Systemic steroids continued nearly lmonth,intravenous and oral steroids usage were about 2 weeks each.Tropical 0.1%FML tapered to 0.02%FML until 2.5 months after initial injury.12 eyes underwent surgery intervention.10 eyes performed AMT,9 of them combined with temporary or permanent blepharorrhaphy.Anti-inflammation medical therapy last 2～3 weeks before surgery.In the mean follow-up of 35.92±14.96 weeks,all eyes reserved eyeball integrity and gained scarring restoration of ocular suface.Conclusions:A new grading system was proposed based on Roper-Hall classification. The new system had consistency with clinical outcomes in severe acute chemical and themal burns.Eyes Of gradeⅢA restored a smooth ocular surface with medical therapy alone and showed better visual recovery.Meanwhile,Eyes of gradeⅣB needed AMT either combined with temporary or permanent blepharorrhaphy to gain a scarring restoration.