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

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.Chemical injuries to the eye induce a wide range of damage to ocular tissues, and severe alkali burns constitute a leading cause of intractable blindness 1,2 . Since the ocular surface is directly exposed to chemical injuries, most studies thus 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 3-7 .By contrast, posterior segment complications following chemical injuries to the ocular surface have been rarely investigated partly because of poor intraocular structure visualization in severely-burned eyes with corneal opacification. Recently, 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 6,8-11 . These findings suggest that glaucoma and retinal damage are important sequelae of ocular chemical injuries. Few studies, however, have examined the incidence and clinical course of glaucoma in patients with ocular chemical burns 10,12-14 .Herein, we investigated the incidence, onset, risk factors, and therapeutic and visual outcomes of glaucoma in patients with ocular chemical burns. Materials and methodsStudy design and subjects.

Glaukoma Po Cheminių Akių Nudegimų

“…Cheminiai nudegimai (52 proc.) įvyksta darbe [13], dažniau pasitaiko vyrams (56,6-60,0 proc.) [13,14].…”

“…įvyksta darbe [13], dažniau pasitaiko vyrams (56,6-60,0 proc.) [13,14]. Neseniai JAV atliktame tyrime nustatyti 5,1 naujų cheminių nudegimų atvejų 100000 gyventojų per metus [15] koreliuoja su Jungtinėje Karalystėje atlikto tyrimo rezultatais -5,6 naujų atvejų 100000 gyventojų per metus [13].…”

“…[13,14]. Neseniai JAV atliktame tyrime nustatyti 5,1 naujų cheminių nudegimų atvejų 100000 gyventojų per metus [15] koreliuoja su Jungtinėje Karalystėje atlikto tyrimo rezultatais -5,6 naujų atvejų 100000 gyventojų per metus [13]. Šie epidemiologiniai duomenys pabrėžia pavojingų cheminių medžiagų saugaus laikymo, švietimo ir prevencijos priemonių svarbą [14,16].…”

“…Ląstelių membranų lizė išlaisvina chemotaksius ir uždegimo tarpininkus, tokius kaip prostaglandinai, leukotrienai ir interleukinai, sukeliančius greitą imunologinį atsaką [17]. Amoniakas lemia sunkiausius akių cheminius nudegimus [5,13], prasiskverbia greičiausiai (<3 min.) [5].…”

Cheminiai Akių Nudegimai

“…S. Choi ir kt. nurodo, kad pacientams, kurių akispūdis po akių cheminių nudegimų buvo daugiau kaip 21mmHg, buvo 151,2 karto didesnė glaukomos išsivystymo rizika [18]. Taikomas medikamentinis glauko-mos gydymas karboanhidrazės inhibitorių, betaadrenoblokatorių, alfaagonistų akių lašais.…”