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Restoration of vision after alkali burn in 11 year old boy. Suzie Nemmers, MD 1 Jason Sorell, DO 1 John Campagna MD, MPHTM 2, Shane McEntire MD3 1Dept Ophthalmology, 2Dept of Pediatrics 3Dept of Surgery Tripler Army Medical Center

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restoration of vision after alkali burn in 11 year old boy

Restoration of vision after alkali burn in 11 year old boy

Suzie Nemmers, MD 1 Jason Sorell, DO 1

John Campagna MD, MPHTM 2, Shane McEntire MD3 1Dept Ophthalmology, 2Dept of Pediatrics 3Dept of Surgery

Tripler Army Medical Center

The views expressed in this poster are those of the authors and do not reflect the official policy

or position of the Department of the Army, Department of Defense of the U.S. Government.

All authors have no financial interests

purpose objective
Purpose/Objective
  • To report the restoration of visual acuity in an 11 year old boy after medical treatment of a severe alkaline burn of both eyes.
background
Background
  • Ocular alkaline burns to the eyes denature proteins in the cornea, conjunctiva, and other ocular structures. The release of collagenases and proteases after injury leads to corneoscleral melting.
  • The role of topical steroids in corneoscleral melting is controversial as they have been postulated to exacerbate this condition.
  • Adjunctive therapy with mucomyst, doxycycline, and amniotic membrane help prevent corneal melting.
  • Amniotic membrane is effective at promoting re-epithelization, reducing inflammation, and scaring.
  • Mucomyst inhibits collagenase whereas tetracyclines exert anti-collagenolytic effects by inhibiting activities of human interstitial collagenases and by preventing the oxidative activation of latent pro-collagenases.
methods
Methods
  • Study Design: Observational case study

“The study protocol was approved by the Human use Committee at Tripler Army Medical center. Investigators adhered to the policies for protection of human subjects as prescribed in 45CFR 46”

results
Results
  • An 11 year old boy sustained ocular alkaline burns bilaterally. After copious irrigation for two days, the ocular pH normalized from ph 9.0.
  • Then he was treated with aggressive medical therapy, which included maxitrol, mucomyst, doxycycline, erythromycin, and cyclopentolate.
  • Later, diamox was added to treat elevated intra-ocular pressure.
  • He developed symblepharons and large epithelial defects bilaterally (OD > OS). Therefore Prokera was applied to the right eye and a bandage contact lens to the left. Then Vigamox and pred-forte were started for 1 week. He was maintained on mucomyst, diamox, doxycycline and lotemax for six months.
  • Symblepharon excission was performed .
  • His visual acuity improved to 20/20 bilaterally. Minimal corneal neovascularization occurred in the right eye.
slide6
Pre-

PRE-TREATMENT

  • 1 (2).BMP
post treatment
post treatment

Post

Treatment

Post treatment

POST-TREATMENT

conclusions
Conclusions
  • Prompt and aggressive medical treatment can restore visual acuity in severe ocular alkali burns.
  • Mucomyst and amniotic membrane may be an important adjunctive therapy in restoring vision.
bibliography
Bibliography
  • Rozenbaum D, Baruchin AM, Dafna Z. Chemical Burns of the Eye with Special reference to Alkali Burns. Burns 1991;17(2):136-140.
  • Najjar DM, Rapuano CJR, Cohen EJ. Descemet Membrane Detachment with Hemorrhage After Alkali Burn to the Cornea. American Journal of Ophthalmology 2004;137(1):185-187.
  • Mackway-Jones K, Marsden, J. Ascorbate for Alkali Burns to the Eye. Emergency Medicine Journal 2003;20:464-470.
  • Meller D, Pires RTF, Mack RJS, et al. Amniotic Membrane Transplantation for Acute Chemical or Thermal Burns. Ophthalmology 2000;107(5):980-989.
  • Solomon A, Meller D, Prabhasawat P, et al. Amniotic Membrane Grafts for Nontraumatic Corneal Perforations, Descemetoceles, and Deep Ulcers. Ophthalmology 2002;109(4):694-703.
  • Bouchard CS, John T. Amniotic Membrane Transplantation in the Management of Severe Ocular Surface Disease: indications and Outcomes. The Ocular Surface 2004;2(3):201-211.
  • Dua HS, Azuara-Blanco A. Discussion. Ophthalmology 2000;107(5):990