Lam Sophia S, Sklar Bonnie A, Schoen Marisa, Rapuano Christopher J
Department of Medical Education, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA.
Department of Ophthalmology, Wills Eye Hospital, Philadelphia PA, USA.
Taiwan J Ophthalmol. 2022 Dec 2;13(1):101-105. doi: 10.4103/2211-5056.362597. eCollection 2023 Jan-Mar.
Alkali injuries are ocular emergencies that require immediate evaluation and therapy to preserve vision. Severe alkali injuries can result in long-term vision-threatening sequelae including symblepharon, corneal ulceration, corneal scarring, limbal stem cell deficiency, xerophthalmia, cicatricial changes of the eyelid and adnexa, glaucoma, uveitis, and permanent vision loss. Treatment is aimed at neutralizing the pH, controlling inflammation, and restoring the ocular surface. Here, we present the case of a 35-year-old male who sustained direct ocular exposure to sodium hydroxide, resulting in significant corneal and conjunctival epithelial defects despite aggressive initial medical therapy. The patient subsequently received a large, externally sutured amniotic membrane (AM) with a customized symblepharon ring to promote healing. The corneal and conjunctival defects resolved, and at 4 months after the initial injury, the patient's visual acuity had improved to 20/25. Clinicians should be aware of the various surgical techniques to place an AM transplantation and identify the best strategy based on clinical findings and the extent and severity of the injury.
碱烧伤是需要立即评估和治疗以保护视力的眼部急症。严重的碱烧伤可导致长期威胁视力的后遗症，包括睑球粘连、角膜溃疡、角膜瘢痕形成、角膜缘干细胞缺乏、干眼症、眼睑及附属器的瘢痕性改变、青光眼、葡萄膜炎以及永久性视力丧失。治疗旨在中和pH值、控制炎症并恢复眼表。在此，我们报告一例35岁男性患者，其眼部直接接触氢氧化钠，尽管初始进行了积极的药物治疗，但仍导致严重的角膜和结膜上皮缺损。该患者随后接受了带定制睑球粘连环的大面积外置缝合羊膜移植术以促进愈合。角膜和结膜缺损得以愈合，初始受伤后4个月，患者视力提高到20/25。临床医生应了解进行羊膜移植的各种手术技术，并根据临床发现以及损伤的范围和严重程度确定最佳策略。
