Brodovsky S C, McCarty C A, Snibson G, Loughnan M, Sullivan L, Daniell M, Taylor H R
Centre for Eye Research Australia, Department of Ophthalmology, University of Melbourne, Melbourne, Victoria, Australia.
Ophthalmology. 2000 Oct;107(10):1829-35. doi: 10.1016/s0161-6420(00)00289-x.
To review the spectrum of patients with alkali burns admitted over an 11-year period and to assess the clinical outcomes after the introduction of a standard alkali burn treatment protocol.
Retrospective nonrandomized comparative study.
A total of 121 patient records with alkali burns (n = 177 eyes) admitted to a tertiary hospital between 1987 and 1998 were reviewed. Eyes treated with a standard alkali burn treatment protocol, which included intensive topical steroids, ascorbate, citrate, and antibiotics, were compared with eyes treated by conservative management with antibiotics, and a short course of steroids.
Time to corneal reepithelialization, final best-corrected visual acuity, and time to visual recovery, length of hospital stay, and complications were analyzed.
The standard protocol tended to delay corneal reepithelialization by one day (P: = not significant) in eyes with grade 1 burns (n = 76) and by 2 days (P: = 0.04) in grade 2 burns (n = 52), with no difference in final visual outcome. There were 37 eyes with grade 3 burns. Those treated with the standard protocol showed a trend toward more rapid corneal reepithelialization. Twenty-seven of 29 (93%) eyes with grade 3 injuries achieved a final best-corrected visual acuity of 20/40 or better compared with 3 of 6 (50%) eyes not treated according to the standard protocol (P: = 0.02). Eyes with grade 4 burns (n = 12), whether treated with the standard protocol or not, required 10 to 12 weeks for corneal reepithelialization. There was no statistically significant difference in final visual acuity.
On the basis of our findings, a number of recommendations can be made for the management of alkali injuries. Patients with a grade 1 or 2 injury do not require routine admission and do not benefit from the use of intensive treatment with ascorbate and citrate. A trend toward more rapid healing and a better final visual outcome were apparent in grade 3 burns, but our standard protocol made no difference in grade 4 burns.
回顾11年间收治的碱烧伤患者情况，并评估采用标准碱烧伤治疗方案后的临床疗效。
回顾性非随机对照研究。
回顾了1987年至1998年间一家三级医院收治的121例碱烧伤患者记录（共177只眼）。将采用标准碱烧伤治疗方案（包括强化局部使用类固醇、抗坏血酸盐、柠檬酸盐和抗生素）治疗的眼与采用抗生素保守治疗并短期使用类固醇治疗的眼进行比较。
分析角膜重新上皮化时间、最终最佳矫正视力、视力恢复时间、住院时间及并发症情况。
在1级烧伤（n = 76）的眼中，标准方案倾向于使角膜重新上皮化延迟1天（P值：无显著差异），在2级烧伤（n = 52）的眼中延迟2天（P值 = 0.04），最终视力结果无差异。有37只眼为3级烧伤。采用标准方案治疗的眼显示出角膜重新上皮化更快的趋势。29只3级损伤眼中的27只（93%）最终最佳矫正视力达到20/40或更好，而未按标准方案治疗的6只眼中只有3只（50%）达到此视力（P值 = 0.02）。4级烧伤的眼（n = 12），无论是否采用标准方案治疗，角膜重新上皮化均需10至12周。最终视力无统计学显著差异。
基于我们的研究结果，对于碱烧伤的处理可提出一些建议。1级或2级损伤的患者无需常规住院，使用抗坏血酸盐和柠檬酸盐强化治疗并无益处。3级烧伤明显有愈合更快和最终视力更好的趋势，但我们的标准方案对4级烧伤并无差异。
