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We read with interest the article 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 amniotic membrane transplantation (AMT) in acute cases with sufficient scientific explanation.
Whenever a new technique is described it is aggressively followed without realising 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 vascularisation of the ischaemic ocular surface, and epithelialisation of the cornea. It is reported in the literature that AMT does help in all these three conditions at the acute stage of burns 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, there should be some time lag between burn and surgery. This may help to reduce inflammation, thus allowing the surgeons to perform an elective surgery. Regarding the stage of the chemical burn, the authors have rightly pointed out that there is a remarkable limitation in modified Roper Hall's classification at grade IV.3 Do the eyes with 100% limbal ischaemia behave in the same way as those with 55% ischaemia?1
It was thought of back in 1984 and a modified classification was suggested in these eyes before keratoplasty as a prognostic factor.4 However, the same factor was restricted to healed lesions and now the time has come for the modification to be needed for acute lesions.
Once again we would like to commend the authors for their boldness and wonder how many other corneal surgeons would have felt the same.
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