Original article
Glaucoma in Patients With Ocular Chemical Burns

https://doi.org/10.1016/j.ajo.2012.03.026Get rights and content

Purpose

To examine the development and management of glaucoma in patients with ocular chemical burns.

Design

Retrospective, observational case series.

Methods

setting: University of Washington Eye Clinics. patient population: Twenty-nine eyes (18 patients) with ocular chemical burns seen between 1997 and 2010 with a minimum of 3 months of follow-up. observation procedure: Eyes were graded using the Roper-Hall scale. main outcome measures: Long-term use of glaucoma medications (3 months or more) and need for glaucoma surgery.

Results

The mean age was 45 ± 17 years, with a mean follow-up of 75 ± 47 months (median, 66 months). Roper-Hall grade III or IV eyes (n = 20) had significantly higher intraocular pressure at presentation (35.9 vs 16.4 mm Hg; P = .001) and over follow-up were more likely to require long-term glaucoma medications (P = .003) or to undergo glaucoma surgery (P = .016) than Roper-Hall grade I or II eyes. Thirteen eyes (12 Roper-Hall grade III or IV) underwent glaucoma surgery. Eight eyes underwent glaucoma tube implant surgery; 4 required at least 1 revision. Seven eyes underwent diode laser cyclophotocoagulation; 4 required repeat treatment. Most (89%) eyes had controlled intraocular pressure at the last follow-up. However, 76% of eyes with visual acuity of 20/200 or worse at initial evaluation did not have improved vision at the last follow-up.

Conclusions

Eyes with Roper-Hall grade III or IV ocular chemical burns were more likely to have glaucoma and to require surgery for it. Outcomes of glaucoma management generally were good, although tube implant surgeries often had complications requiring revision.

Section snippets

Methods

We reviewed patients seen between 1997 and 2010 at the Eye Clinics of the University of Washington (University of Washington Medical Center and Harborview Medical Center). Patients were identified by International Classification of Disease, Ninth Edition, code search for ocular burns (940.0 through 940.5). Patients with ocular chemical burns with at least 3 months of follow-up were included in the study. Although glaucoma usually is assessed though evaluation of the optic nerve and visual

Results

Twenty-nine eyes (18 patients) with ocular chemical burns were identified and met inclusion criteria (Table 1). The mean patient age was 45.4 ± 16.7 years (range, 19 to 77 years), and mean follow-up was 75 ± 47 months (median, 66 months; range, 10 to 157 months). Most patients were male (15/18; 83%) and white (15/18; 83%). Twenty-four eyes (83%) had alkali burns with a mean pH of 9.38, whereas 5 eyes (17%) had acid burns. Among eyes with alkali burns, 68% (15/22) had visual acuity of 20/200 or

Discussion

Severe ocular chemical burns remain a challenging area for both visual rehabilitation and glaucoma treatment, although improvements have been made in the management of ocular chemical burns in recent years.10, 11 Vision loss from chemical burns is not limited to the direct causative injury to the ocular surface, but may also occur as a result of acute and chronic optic nerve damage from uncontrolled IOP. Glaucoma as a result of alkali burns may be immediate or delayed.12 In 1946, Hughes

Michelle Lin is a medical student at the University of Washington School of Medicine, Seattle, Washington. She received her MPH degree from the Dartmouth Institute for Health Policy & Clinical Practice. Michelle is passionate about outcomes research, innovation and technology development in vision science. She is currently pursuing a research fellowship at the Cleveland Clinic/Cole Eye Institute.

References (23)

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    Thermal and chemical burns

    Trans Ophthalmol Soc U K

    (1965)
  • Cited by (0)

    Michelle Lin is a medical student at the University of Washington School of Medicine, Seattle, Washington. She received her MPH degree from the Dartmouth Institute for Health Policy & Clinical Practice. Michelle is passionate about outcomes research, innovation and technology development in vision science. She is currently pursuing a research fellowship at the Cleveland Clinic/Cole Eye Institute.

    Ümit Ekşioğlu is currently practicing at Department of Ophthalmology, Ankara Training and Research Hospital, Ankara, Turkey.

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