We read with interest the article titled "Failure of amniotic membrane transplantation (AMT) in the treatment of acute ocular burns" by Joseph et al[1]. It is to be appreciated that they have come forward to report the negative results of their study along with the need of an upgraded classification for the chemical burn. The authors must be congratulated for highlighting the pitfalls of the AMT in acute cases with sufficient scientific explanation.

Whenever a new technique is described, it is aggressively followed without realizing the consequences. The authors have very rightly suggested that the most important strategy for the management of thermal and chemical burns in the acute stage is to reduce inflammation, promote vascularization of the ischaemic ocular surface and epithelialisation of the cornea. It is reported in the literature that AMT does help in all these 3 conditions at acute stage of burn for which the procedure is advocated[2]. but when and to what stage? It is essential to have some amount of healthy conjunctival tissue for graft to take up. Further, rather than performing the AMT at an acute stage, some gap should be given between burn and surgery. This may help to reduce inflammation, thus, allowing the surgeons to perform an elective surgery. As regards to the stage of the chemical burn, the author has very rightly pointed out that there is a remarkable limitation in modified Roper Halls classification at grade IV[3]. Do the eyes with 100% limbal ischaemia behave the same as those with 55% ischaemia1. Dating back to 1984 it was thought of and a modified classification was suggested in these eyes prior to keratoplasty as a prognostic factor[4]. However, the same was restricted to healed lesions and now the time has come the modification is needed for acute lesions.

Once again we would like to commend the authors for their boldness and wonder how many of the corneal surgeons would have felt the same.

References:
(1) Joseph A, Dua HS, King AJ. Failure of amniotic membrane transplantation (AMT) in the treatment of acute ocular burns. Br. Jour Ophthalmol 2001;85:1065-9.
(2) Mellor D, Renato TF, Pires et al. AMT for acute chemical or thermal burns. Ophthalmology 2001;107:980-90.
(3) Roper Hall MJ. Thermal and chemical burns. Trans ophthalmol soc UK 1965;85-631-40.
(4) Panda A, Mohan M, Gupta AK, Chowdhary S. Keratoplasty in alkali burned corneas. Indian J. Ophthalmol 1984;32:441-6