Glaucoma after ocular chemical burns: Incidence, risk factors, and outcome

Se Hyun Choi,Mee Kum Kim,Joo Youn Oh

doi:10.1038/s41598-020-61822-5

Abstract

Effects of chemical injuries on the cornea and limbus have been widely studied; however, little is known about glaucoma after ocular chemical injuries. We herein investigated the incidence, risk factors, and outcome of glaucoma in patients with ocular chemical burns. Medical records were reviewed of patients who visited our clinic for chemical injuries to the ocular surface. Patients were divided into glaucoma and non-glaucoma groups based on high intraocular pressure (IOP) readings. Clinical characteristics, treatment method, and therapeutic and visual outcomes were compared between the two groups. Of 29 patients (40 eyes), 9 patients (15 eyes, 37.5%) were diagnosed with glaucoma at 2.64 ± 2.92 months after injury. Factors associated with glaucoma included male gender (p = 0.0114), bilateral ocular involvement (p = 0.0478), severe ocular surface involvement (Dua grades IV-VI, p = 0.0180), poor initial visual acuity (p = 0.0136), high initial IOP (p < 0.0001), pupil involvement at initial examination (p = 0.0051), and the need for amniotic membrane transplantation in the acute stage (p = 0.0079). At final follow-up, IOP was uncontrolled in 3 eyes (20.0%), and visual acuity was worse in the glaucoma group than in the non-glaucoma group (logMAR 2.94 ± 1.86 vs 0.34 ± 0.69, p < 0.0001). These findings suggest that careful evaluation and intensive treatment for glaucoma are essential in patients with severe ocular burns.

Highlights

Effects of chemical injuries on the cornea and limbus have been widely studied; little is known about glaucoma after ocular chemical injuries
Since the ocular surface is directly exposed to chemical injuries, most studies far have concentrated on investigating the effects of chemical injuries on the cornea and limbus, and the resulting corneal stromal scarring and limbal epithelial stem cell deficiency have been considered a major cause of vision loss in patients with ocular chemical burns[3,4,5,6,7]
Our data demonstrate that glaucoma developed in 37.5% of eyes with ocular chemical burns at the mean 2.64 months after injury

Summary

Introduction

Effects of chemical injuries on the cornea and limbus have been widely studied; little is known about glaucoma after ocular chemical injuries. At final follow-up, IOP was uncontrolled in 3 eyes (20.0%), and visual acuity was worse in the glaucoma group than in the non-glaucoma group (logMAR 2.94 ± 1.86 vs 0.34 ± 0.69, p < 0.0001) These findings suggest that careful evaluation and intensive treatment for glaucoma are essential in patients with severe ocular burns. As the long-term restoration of corneal transparency can be achieved in eyes with severe chemical burns due to surgical advances in limbal cell transplantation and artificial cornea implantation, the unexpected observations of optic disc pallor and retinal degeneration have been reported[6,8,9,10,11] These findings suggest that glaucoma and retinal damage are important sequelae of ocular chemical injuries. We investigated the incidence, onset, risk factors, and therapeutic and visual outcomes of glaucoma in patients with ocular chemical burns

Methods

Results

Conclusion