Chemical burns: Diphoterine untangled

Alexander, Skaria; Wasiak, Jason; Cleland, Heather

doi:10.1016/j.burns.2017.09.017

Cited by 18 publications

(10 citation statements)

References 27 publications

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“…At times, tissue impregnated with the particulate matter will need to be excised to remove the chemical. Amphoteric chelating agent such as ethylenediamine tetra acetic acid (EDTA), Diphoterine®, hexafluorine, and Cederroth Eye Wash are viable alternative options [45][46][47][48]. Diphoterine is amphoteric (can act as acid or alkali, i.e.…”

Section: Removal Of Inciting Agent and Prevention Of Further Damagementioning

confidence: 99%

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Chemical eye injury: pathophysiology, assessment and management

Dua

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Saadi

et al. 2020

Eye

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Chemical eye injury (CEI) is an acute emergency which can threaten sight and life. These commonly occur at home or the workplace with the former being generally mild and the latter more severe and bilateral. Major workplace accidents involve other parts of the body and can be associated with inhalation or ingestion of the chemical. Alkali injuries cause damage by saponification of tissue and deeper penetration as a consequence. Acid injuries cause rapid coagulation of tissue, which impedes penetration and limits damage. Irritants such as alcohols, cause superficial epithelial denudation. Severe chemical insult can affect all anterior segment structures causing iris, pupil and lens abnormalities. Eye pressure is variably affected and can be low or high or start as one and rapidly change to the other. Chorioretinal changes in the form of vasculopathy are seen and ascribed to be secondary to anterior segment inflammation rather than due to the direct effect of CEI. Final outcome related to structure and function is determined by the injurious agent, duration of exposure, nature of treatment and the rapidity with which it is instituted. Prevention of further damage by profuse and prolonged eye wash, after ascertaining pH of both eyes, together with exploration and removal of all particulate matter, is the key. Other management principles include a complete and thorough assessment, control of inflammation, facilitation of healing and prevention and management of sequelae and complications. Intraocular pressure is often forgotten and must be assessed and managed. Management often requires a multidisciplinary approach.

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Section: Removal Of Inciting Agent and Prevention Of Further Damagementioning

confidence: 99%

“…neutralise both types of agents) and hypertonic. Such agents have been shown to rapidly neutralise pH and reduce tissue necrosis, with minimal exothermic reaction [45]. Once the pH returns to normal, irrigation should be stopped for ~5 min and the pH tested again.…”

Section: Removal Of Inciting Agent and Prevention Of Further Damagementioning

confidence: 99%

Chemical eye injury: pathophysiology, assessment and management

Dua

Ting

Saadi

et al. 2020

Eye

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“…Diphoterine is a polyvalent, amphoteric, and slightly hypertonic solution that was first developed in France and is licenced in Europe as a class II medical device for treating chemical injury of skin and eyes. 6 , 7 Pre-clinical studies have demonstrated that Diphoterine was able to minimise pain and expedite wound healing by increasing the level of beta-endorphin and inhibiting the release of substance P. 13 In addition, a few clinical studies have highlighted that Diphoterine could reduce the severity of CEI when compared to normal saline irrigation. 10 , 11 Although the use of Diphoterine has been reported and adopted in certain parts of Europe, 10 , 11 , 14 only one case has been reported in the United Kingdom in relation to the efficacy of Diphoterine for ocular and cutaneous burn.…”

Section: Discussionmentioning

confidence: 99%

“… 6 , 7 Compared to saline which works by diluting the chemicals at the site of injury, Diphoterine has active binding sites for both acidic and alkali agents, 8 rendering it a more effective treatment for CEI. Despite its ability to rapidly neutralise the pH and reduce tissue necrosis, 6 Diphoterine has not been widely adopted in the management of CEI in many countries, including the United Kingdom, primarily attributed to the limited clinical evidence available in the literature. 6 , 9 – 11 In view of the paucity of literature, our study aims to report the clinical outcomes and safety of Diphoterine in managing CEI in the United Kingdom.…”

Section: Introductionmentioning

confidence: 99%

“…5 Diphoterine ® is a sterile solution with amphoteric, polyvalent, and chelating properties and is licenced in Europe as a class-II medical device for use for chemical injuries involving the skin and eye. 6,7 Compared to saline which works by diluting the chemicals at the site of injury, Diphoterine has active binding sites for both acidic and alkali agents, 8 rendering it a more effective treatment for CEI. Despite its ability to rapidly neutralise the pH and reduce tissue necrosis, 6 Diphoterine has not been widely adopted in the management of CEI in many countries, including the United Kingdom, primarily attributed to the limited clinical evidence available in the literature.…”

Section: Introductionmentioning

confidence: 99%

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Clinical outcomes and safety of Diphoterine^® irrigation for chemical eye injury: A single-centre experience in the United Kingdom

et al. 2021

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Purpose: Diphoterine® is an amphoteric irrigating solution armed with rapid pH-neutralising action. It serves as an effective first-aid treatment for managing chemical burns, including chemical eye injury (CEI). However, its use is not widely adopted in current clinical practice, primarily attributed to limited clinical evidence. This study aims to highlight the experience in using Diphoterine for managing CEI in a UK tertiary referral centre. Methods: This retrospective case series included all patients who presented with CEI and treated with Diphoterine at the James Cook University Hospital, UK, between April 2018 and February 2020. Results: Seven patients (10 eyes) were included; the mean age was 28.2 ± 17.0 years (ranged, 3–70 years) and 85.7% were male. All patients presented with an alkaline injury with a mean presenting pH of 8.7 ± 0.7 and a median (±interquartile range [IQR]) corrected-distance visual acuity (CDVA) of 0.10 ± 0.28 logMAR. Based on Roper-Hall classification, 90% and 10% of the eyes were of grade-I and -IV CEI, respectively. All eyes received normal saline/water as the first irrigation fluid and Diphoterine as second irrigation fluid. The mean pH improved slightly after first irrigation (8.4 ± 0.7; p = 0.13) and significantly after second irrigation (7.6 ± 0.4; p = 0.001). The volume of irrigation used was significantly less for Diphoterine (520 ± 193 mL) than for normal saline/water (2700 ± 2451 mL; p = 0.016). At final follow-up (median = 5 days), the median CDVA remained stable at 0.10 ± 0.28 logMAR ( p = 0.60). One patient developed near-total limbal stem cell deficiency as a complication of grade-IV injury and was awaiting limbal stem cell transplantation at last follow-up. Conclusion: This study represents the first case series in the United Kingdom, reporting the use of Diphoterine in managing CEI. The rapid pH-neutralising action of Diphoterine, with less volume required, makes it an ideal initial treatment for efficiently managing adult and paediatric patients with CEI in clinics.

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