Indocyanine Green Angiographic Features in a Case of Alkali Retinopathy

Abstract

Alkaline substances can penetrate sclera. Ocular alkali burns can result in choroidal ischemia and retinal necrosis. It is important to suspect posterior segment complications in all ocular alkali injuries. This case emphasizes the necessity of prompt irrigation of the conjunctival cul de sac and the removal of any solid chemical remnants after ocular alkali injuries.

Thermal ocular injury associated with retinal necrosis and vitreous inflammation: a case report

“…Because the screw was embedded directly in the deep tissue, the corneal involvement was mild and the clear cornea allowed us to observe the changes in the fundus. There has been a similar reported case of an alkali burn in which the alkaline substance penetrated through the conjunctiva, sclera, choroid, and retina, resulting in full-thickness necrosis ( 8 ). Much like chemical burns, the severity of thermal eye burns is related to the duration of exposure and the nature of the causative agent.…”

Thermal ocular injury associated with retinal necrosis and vitreous inflammation: a case report

“…Because the screw was embedded directly in the deep tissue, the corneal involvement was mild and the clear cornea allowed us to observe the changes in the fundus. There has been a similar reported case of an alkali burn in which the alkaline substance penetrated through the conjunctiva, sclera, choroid, and retina, resulting in full-thickness necrosis ( 8 ). Much like chemical burns, the severity of thermal eye burns is related to the duration of exposure and the nature of the causative agent.…”

Expanding the Spectrum of Alkali Retinopathy: Maculopathy following Alkali Burn

“…The focus is (initially) mainly on the anterior segment as corneal opacification precludes a detailed posterior segment examination. Only a few cases of alkali retinopathy have been described [ 3 , 6 ]. Several mechanisms have been suggested for posterior segment damage and persistent visual loss following alkali ocular burn.…”

“…Second, a direct penetration of the alkalic component through the sclera to involve both the choroid and the retina is suggested by the sharp localization of the retinopathy just internal to the obvious external burn in 3 previous reported patients with alkali retinopathy. In these patients, ocular penetration induced an ischemic necrosis not only of the conjunctiva and sclera but also of the choroid and retina [ 3 , 6 ]. Remarkably, in our patient, retinal damage was limited to the macular region, extending to the inferonasal part of the posterior pole.…”

“…Multiple mechanisms Vanclooster et al: Expanding the Spectrum of Alkali Retinopathy: Maculopathy following Alkali Burn have been postulated; some of them include a role of the intraocular pressure (IOP) because of typical IOP-induced optic disc changes [1,4,5]. Others suggest a direct pH-related alkali diffusion from the AC to the back of the eye, leading to cell toxicity and retinal damage [3,6]. In recent mouse and rabbit studies, a mechanism in which retinal damage was caused by upregulation and diffusion of inflammatory cytokines, especially tumor necrosis factor alpha (TNF-α), from the site of the injury to the posterior segment was suggested [1,4,[7][8][9].…”

Thermal ocular injury associated with retinal necrosis and vitreous inflammation: a case report

“…Because the screw was embedded directly in the deep tissue, the corneal involvement was mild and the clear cornea allowed us to observe the changes in the fundus. There has been a similar reported case of an alkali burn in which the alkaline substance penetrated through the conjunctiva, sclera, choroid, and retina, resulting in full-thickness necrosis ( 8 ). Much like chemical burns, the severity of thermal eye burns is related to the duration of exposure and the nature of the causative agent.…”

Expanding the Spectrum of Alkali Retinopathy: Maculopathy following Alkali Burn

“…The focus is (initially) mainly on the anterior segment as corneal opacification precludes a detailed posterior segment examination. Only a few cases of alkali retinopathy have been described [ 3 , 6 ]. Several mechanisms have been suggested for posterior segment damage and persistent visual loss following alkali ocular burn.…”

“…Second, a direct penetration of the alkalic component through the sclera to involve both the choroid and the retina is suggested by the sharp localization of the retinopathy just internal to the obvious external burn in 3 previous reported patients with alkali retinopathy. In these patients, ocular penetration induced an ischemic necrosis not only of the conjunctiva and sclera but also of the choroid and retina [ 3 , 6 ]. Remarkably, in our patient, retinal damage was limited to the macular region, extending to the inferonasal part of the posterior pole.…”

“…Multiple mechanisms Vanclooster et al: Expanding the Spectrum of Alkali Retinopathy: Maculopathy following Alkali Burn have been postulated; some of them include a role of the intraocular pressure (IOP) because of typical IOP-induced optic disc changes [1,4,5]. Others suggest a direct pH-related alkali diffusion from the AC to the back of the eye, leading to cell toxicity and retinal damage [3,6]. In recent mouse and rabbit studies, a mechanism in which retinal damage was caused by upregulation and diffusion of inflammatory cytokines, especially tumor necrosis factor alpha (TNF-α), from the site of the injury to the posterior segment was suggested [1,4,[7][8][9].…”

Thermal ocular injury associated with retinal necrosis and vitreous inflammation: a case report

“…Because the screw was embedded directly in the deep tissue, the corneal involvement was mild and the clear cornea allowed us to observe the changes in the fundus. There has been a similar reported case of an alkali burn in which the alkaline substance penetrated through the conjunctiva, sclera, choroid, and retina, resulting in full-thickness necrosis ( 8 ). Much like chemical burns, the severity of thermal eye burns is related to the duration of exposure and the nature of the causative agent.…”

Expanding the Spectrum of Alkali Retinopathy: Maculopathy following Alkali Burn

“…The focus is (initially) mainly on the anterior segment as corneal opacification precludes a detailed posterior segment examination. Only a few cases of alkali retinopathy have been described [ 3 , 6 ]. Several mechanisms have been suggested for posterior segment damage and persistent visual loss following alkali ocular burn.…”

“…Second, a direct penetration of the alkalic component through the sclera to involve both the choroid and the retina is suggested by the sharp localization of the retinopathy just internal to the obvious external burn in 3 previous reported patients with alkali retinopathy. In these patients, ocular penetration induced an ischemic necrosis not only of the conjunctiva and sclera but also of the choroid and retina [ 3 , 6 ]. Remarkably, in our patient, retinal damage was limited to the macular region, extending to the inferonasal part of the posterior pole.…”

“…Multiple mechanisms Vanclooster et al: Expanding the Spectrum of Alkali Retinopathy: Maculopathy following Alkali Burn have been postulated; some of them include a role of the intraocular pressure (IOP) because of typical IOP-induced optic disc changes [1,4,5]. Others suggest a direct pH-related alkali diffusion from the AC to the back of the eye, leading to cell toxicity and retinal damage [3,6]. In recent mouse and rabbit studies, a mechanism in which retinal damage was caused by upregulation and diffusion of inflammatory cytokines, especially tumor necrosis factor alpha (TNF-α), from the site of the injury to the posterior segment was suggested [1,4,[7][8][9].…”