Restoration of vision after alkali burn in 11 year old boy

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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

      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
   To report the restoration of visual acuity in an
    11 year old boy after medical treatment of a
    severe alkaline burn of both eyes.
   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.
    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”
   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
   Symblepharon excission was performed .
   His visual acuity improved to 20/20 bilaterally. Minimal corneal
    neovascularization occurred in the right eye.
   1 (2).BMP
POST-TREATMENT     Post treatment   Post
                post
   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.
   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
   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
   Dua HS, Azuara-Blanco A. Discussion. Ophthalmology 2000;107(5):990

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