Restoration of vision Restoration of vision after alkali burn in 11 after alkali burn in 11

year old boyyear old boy Suzie Nemmers, MD 1 Jason Sorell, DO 1 Suzie Nemmers, MD 1 Jason Sorell, DO 1

John Campagna MD, MPHTM 2, Shane McEntire MD3 John Campagna MD, MPHTM 2, Shane McEntire MD3 1Dept Ophthalmology, 2Dept of Pediatrics 3Dept of Surgery 1Dept Ophthalmology, 2Dept of Pediatrics 3Dept of Surgery

Tripler Army Medical CenterTripler Army Medical Center

The views expressed in this poster are those of the authors and do not reflect the official policy 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.or position of the Department of the Army, Department of Defense of the U.S. Government.

All authors have no financial interests All authors have no financial interests

Purpose/ObjectivePurpose/Objective

To report the restoration of visual To report the restoration of visual acuity in an 11 year old boy after acuity in an 11 year old boy after medical treatment of a severe medical treatment of a severe alkaline burn of both eyes. alkaline burn of both eyes.

BackgroundBackground Ocular alkaline burns to the eyes denature proteins in the Ocular alkaline burns to the eyes denature proteins in the

cornea, conjunctiva, and other ocular structures. The cornea, conjunctiva, and other ocular structures. The release of collagenases and proteases after injury leads to release of collagenases and proteases after injury leads to corneoscleral melting. corneoscleral melting.

The role of topical steroids in corneoscleral melting is The role of topical steroids in corneoscleral melting is controversial as they have been postulated to exacerbate controversial as they have been postulated to exacerbate this condition. this condition.

Adjunctive therapy with mucomyst, doxycycline, and Adjunctive therapy with mucomyst, doxycycline, and amniotic membrane help prevent corneal melting. amniotic membrane help prevent corneal melting.

Amniotic membrane is effective at promoting re-Amniotic membrane is effective at promoting re-epithelization, reducing inflammation, and scaring. epithelization, reducing inflammation, and scaring.

Mucomyst inhibits collagenase whereas tetracyclines exert Mucomyst inhibits collagenase whereas tetracyclines exert anti-collagenolytic effects by inhibiting activities of human anti-collagenolytic effects by inhibiting activities of human interstitial collagenases and by preventing the oxidative interstitial collagenases and by preventing the oxidative activation of latent pro-collagenases. activation of latent pro-collagenases.

MethodsMethods

Study Design: Observational case Study Design: Observational case studystudy

““The study protocol was approved by the Human use Committee at Tripler Army Medical center. 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”Investigators adhered to the policies for protection of human subjects as prescribed in 45CFR 46”

ResultsResults An 11 year old boy sustained ocular alkaline burns An 11 year old boy sustained ocular alkaline burns

bilaterally. After copious irrigation for two days, the bilaterally. After copious irrigation for two days, the ocular pH normalized from ph 9.0. ocular pH normalized from ph 9.0.

Then he was treated with aggressive medical therapy, Then he was treated with aggressive medical therapy, which included maxitrol, mucomyst, doxycycline, which included maxitrol, mucomyst, doxycycline, erythromycin, and cyclopentolate. erythromycin, and cyclopentolate.

Later, diamox was added to treat elevated intra-ocular Later, diamox was added to treat elevated intra-ocular pressure. pressure.

He developed symblepharons and large epithelial defects He developed symblepharons and large epithelial defects bilaterally (OD > OS). Therefore Prokera was applied to bilaterally (OD > OS). Therefore Prokera was applied to the right eye and a bandage contact lens to the left. Then the right eye and a bandage contact lens to the left. Then Vigamox and pred-forte were started for 1 week. He was Vigamox and pred-forte were started for 1 week. He was maintained on mucomyst, diamox, doxycycline and lotemax maintained on mucomyst, diamox, doxycycline and lotemax for six months. for six months.

Symblepharon excission was performed . Symblepharon excission was performed . His visual acuity improved to 20/20 bilaterally. Minimal His visual acuity improved to 20/20 bilaterally. Minimal

corneal neovascularization occurred in the right eye.corneal neovascularization occurred in the right eye.

Pre-Pre-

1 (2).BMP1 (2).BMP

PRE-TREATMENT

Post treatmentPost treatment

post post treatmenttreatment

PostPost

TreatmentTreatment

POST-TREATMENT

ConclusionsConclusions

Prompt and aggressive medical Prompt and aggressive medical treatment can restore visual acuity treatment can restore visual acuity in severe ocular alkali burns. in severe ocular alkali burns.

Mucomyst and amniotic membrane Mucomyst and amniotic membrane may be an important adjunctive may be an important adjunctive therapy in restoring vision. therapy in restoring vision.

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