Clinical Spectrum and Treatment Approaches in Corneal Burns

Abstract

Objectives: To evaluate the clinical findings, treatment modalities and long-term prognosis of chemical and thermal burns of the cornea.

Materials and methods: Twenty-one patients (27 eyes) who were followed at two centers for corneal chemical and thermal burns between 2001 and 2013 were included. Eyes were grouped into four grades according to the severity of burn using Roper-Hall classification. Age, gender, type of burn, follow-up duration, corrected visual acuity before and after treatment, treatment modalities and complications were recorded. Patients received medical treatment or combined surgical treatment including amniotic membrane transplantation (AMT), conjunctivolimbal autograft/allograft (CLAU/CLAL) transplantation, keratolimbal allograft (KLAL) or penetrating keratoplasty (PKP).

Results: Patients had a mean age of 27.1±15.5 years (range, 6 months-56 years) and were followed for a mean 63.2±58.6 weeks (4-160 weeks). Significant improvement was achieved with medical treatment alone in patients with grade I (4 eyes) and 2 burns (8 eyes). Patients with grade III burns (11 eyes) underwent CLAU (6 eyes), combined AMT/CLAU (3 eyes), AMT/CLAL (1 eye), or CLAL+PKP (1 eye), while patients with grade IV burns (4 eyes) had keratectomy+CLAL/AMT (1 eye), keratectomy+CLAL+PKP after recurrence with CLAU/AMT (1 eye), CLAU+PKP (1 eye), and AMT/KLAL+PKP (1 eye). All patients except the latter showed ocular surface stabilization with these procedures.

Conclusion: Ocular burns cause severe impairment of the ocular surface. It is possible to achieve good results with appropriate medical treatment and surgeries including ocular surface reconstruction.

Keywords: Ocular surface; alkali burn; medical treatment; surgical treatment.

Figure 1. Patient with grade II burn. a, b) Pre-treatment anterior segment photographs, c, d) Post-treatment anterior segment photographs. Peripheral corneal vascularization has decreased and corneal opacity has disappeared with treatment.

Figure 2. Patient with grade III burn. a, b) Pre-treatment images from a patient with grade III burn. c) The same patient 1 month after limbal autograft and amniotic membrane transplantation. d) The same patient at 3 months after treatment.

Figure 3. Patient with grade IV burn. a) Pre-treatment condition of a patient with grade IV burn. b) The same patient 6 months after keratolimbal allograft transplantation and penetrating keratoplasty