Citation

Sharma N, Singh D, Sobti A, Agarwal P, Velpandian T, Titiyal JS, Ghose S. Am. J. Ophthalmol. 2012; 154(4): 740-749.e2.

Affiliation

Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India.

Copyright

(Copyright © 2012, Elsevier Publishing)

DOI

10.1016/j.ajo.2012.04.018

PMID

22840487

Abstract

PURPOSE: To evaluate the course and outcome of patients with accidental ocular alkali burns. DESIGN: Prospective, interventional case series. METHODS: Study of a cohort of 16 patients (31 eyes) who sustained concomitant accidental sodium hydroxide ocular burns and received appropriate treatment at a tertiary care eye hospital in India. The patients were followed up for 1 year, and parameters including best-corrected visual acuity, epithelial defect area, conjunctival and limbal involvement, and injury-related complications were evaluated. RESULTS: Severe sodium hydroxide exposure of a mean duration of 12 ± 2.5 minutes and delay in specialist eye care caused moderate to severe injury (grade II, 19% [n = 6]; grade III, 19% [n = 6]; grade IV, 10% [n = 3]; and grade VI, 52% [n = 16]). Median best-corrected visual acuity at presentation was 1.0 logarithm of the minimal angle of resolution (logMAR) units (range, 0.3 to 1.9 logMAR units), and at 1 year, it was 1.0 logMAR units (range, 0 to 1.9 logMAR units; P = .121). The median initial epithelial defect was 100 mm(2) (range, 18 to 121 mm(2)), which healed in all eyes by 3.5 months. Initial median limbal involvement was 12 clock hours (range, 3 to 12 clock hours), resulting in a residual limbal stem cell deficiency of 6 clock hours (range, 0 to 12 clock hours) at 1 year. Most common complications were glaucoma and cataract. Corneal ulcers developed in 2 eyes, and keratolimbal graft was performed in 1 patient. Grade VI injuries had significantly worse outcome than the lower-grade injuries. CONCLUSIONS: The course and outcome of ocular alkali burns depends on effective first aid (including a thorough eyewash), age, initial grade of injury, response to treatment, prevention of secondary infection, and control of glaucoma. Despite appropriate treatment, these eyes responded poorly and carried a guarded visual prognosis.

Language: en