[Intraocular complications after severe chemical burns--incidence and surgical treatment]

Abstract

Background: The prognosis of severe eye burns is determined by the area of the injured conjunctiva and the damage of the cornea. Furthermore the extension of damage to intraocular structures influences the clinical course and the surgical management.

Patients: The clinical course of 66 patients with 90 severely burnt eyes in the time from January 1985 to December 1993 were examined with special regard to primary and secondary intraocular complications.

Results: In 62 (68.9%) eyes, the whole anterior eye segment was burnt, while in 28 (31.1%) eyes the damage was limited to the cornea and limbus. A cataract occurred in 23 (25.6%) eyes short time after the burn and an early secondary glaucoma in 14 (15.6%) eyes. In the further clinical course, 41 (45.6%) eyes developed a secondary cataract and 20 (22.2%) eyes a late secondary glaucoma. Within 3 months after the burn, 18 eyes were treated with a Tenon plasty, a penetrating keratoplasty and a cataract extraction. In 12 eyes a cataract extraction was combined with a penetrating keratoplasty more than one year after the injury. In the other cases cataract extraction and keratoplasty were performed in separate operations. In 8 eyes intraocular lenses were implanted. In 15 (16.6%) eyes secondary glaucoma had to be treated by trabeculectomy or by the implantation of a von Denffer implant. Penetrating keratoplasty was performed in 55 eyes, 35 of them were unsuccessful as a consequence of graft rejection or increasing vascularisation. One third of the patients achieved a long-term visual acuity of 0.1 and more.

Conclusion: After severe burn a high rate of intraocular complications has to be expected. The surgical management of such eyes differs from standard procedures. Principally, all devitalized tissue of the anterior chamber like fibrinous and retrocorneal membranes should be excised in an early stage after the burn. Penetrating keratoplasties and extraction of the cataractous lens should be performed in a combined procedure. The implantation of an intraocular lens is limited to a few special cases.