Alkaline Burn Research Articles

Transscleral YAG Laser Photocoagulation for Uncontrollable Glaucoma in Corneal Patients

Control of intraocular pressure (IOP) in patients with severe alkaline burns is one of the most difficult problems facing the corneal specialist. Currently, when medical therapy cannot control intraocular pressure, the usual procedure of choice is cyclocryotherapy. This procedure, however, can be complicated by phthisis, retinal detachment, or macular edema. We have used transscleral YAG laser cyclophotocoagulation (TSYLC) to control the IOP in a patient with severe glaucoma after an alkali burn. This patient had previously had an unsuccessful cyclocryotherapy. After the TSYLC procedure, he suffered no complications and his IOP was normal. Our experience with this patient indicated that the TSYLC procedure might be an effective alternate to cyclocryotherapy, especially in corneal patients with uncontrollable inflammatory glaucoma.

Clinical and experimental studies concerning circulating antibodies to corneal epithelium antigens.

Corneal epithelium antibodies were detected in patients with corneal melting disease (55%), uveitis (42%), corneal transplantation (42%) and marginal furrow disease (20%). These antibodies were not found in herpetic keratitis patients. In control groups, consisting of ocular surgery patients (glaucoma, retinal detachment and cataract) and persons without a history of ocular disease, approximately 4% of the subjects had these antibodies. To investigate the possible role of trauma to the cornea as an initiator of corneal epithelium antibodies, these antibodies were determined in rabbits after alkaline burns were made on the cornea. These antibodies were detected one week later and disappeared after six weeks. Serum from three patients with corneal melting disease and corneal transplantation containing a high antibody titre against corneal epithelium were used to isolate corneal epithelium antigens. A 54 kD and a 17 kD corneal epithelium antigen were isolated. The incidence of autoantibodies directed against these antigens was investigated in patients with corneal melting disease, uveitis and corneal transplantation using an ELISA. 50% of the sera positive in the immunofluorescence test were positive in the ELISA.

Gastric damage from ingested acid in children

Acid ingestion occurs relatively rarely and produces a spectrum of injury that is markedly different from the more commonly encountered alkaline burns of the oropharynx and esophagus. Gastric damage results from pylorospasm with pooling of the ingested caustic in a dependent location. Symptoms may be delayed for days or weeks. Perforation and/or strictures may require extensive gastric surgery. Early fiberoptic endoscopy is essential.

MANAGEMENT OF CHEMICAL EYE INJURIES WITH PROLONGED IRRIGATION

To study the effect of prolonged irrigation in the treatment of chemical eye injuries we reviewed the case records of 172 patients. Most of the patients were men in working age. The injury was caused by acid in 57 patients (33%). Of the acid burns, 28 were due to AIV solution commonly used in agriculture in Finland, and 27 were due to inorganic acids. Alkaline burns occurred in 64 (37%) patients including 33 cases with natrium hydroxide and 20 cases with mortar and cement burns. Other chemicals including organic solvents and surfactants caused the eye burn in 51 (30%) cases. Fifty three patients mostly with alkaline and acid burns were treated with prolonged irrigation with one liter of physiological saline using intravenous delivery system during 1-2 hours. The extent of damage was smaller, the visual outcome better, and the duration of treatment at the hospital and absence from work were shorter in patients treated with prolonged irrigation than without such treatment.

ADMISSION URINALYSIS AND EYE BURNS

To the Editor. —It has been my impression that a degree of albumin is usually present in the first admission urinalysis in patients suffering from alkaline burns of the eyes. I am wondering if some of your readers have noted this also.