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Chemical Burns of the Eye: The Role of Retinal Injury and New Therapeutic Possibilities
Claes H Dohlman1, Fabiano Cade, Caio V Regatieri
1Cornea Service and Boston Keratoprosthesis Laboratory, Massachusetts Eye and Ear Infirmary and Schepens Eye Research Institute, Harvard Medical School, Boston, MA.
Purpose:
To propose a new treatment paradigm for chemical burns to the eye - in the acute and chronic phases.
Methods:
Recent laboratory and clinical data on the biology and treatment of chemical burns are analyzed.
Results:
Corneal blindness from chemical burns can now be successfully treated with a keratoprosthesis, on immediate and intermediate bases. Long term outcomes, however, are hampered by early retinal damage causing glaucoma. New data suggest that rapid diffusion of inflammatory cytokines posteriorly (TNF-α, etc) can severely damage the ganglion cells. Prompt anti-TNF-α treatment is markedly neuroprotective. Long term profound reduction of the intraocular pressure is also vital.
Conclusion:
A new regimen, in addition to standard treatment, for severe chemical burns is proposed. This involves tumor necrosis factor alpha (TNF-α) inhibition promptly after the accident (primarily for retinal neuroprotection), prophylactic maximal lowering of the intraocular pressure (starting immediately), and keratoprosthesis implantation in a later quiet state.
