Lata Suman, Bari Aafreen, Agarwal Tushar
Ophthalmology, All India Institute of Medical Sciences, New Delhi, IND.
Cureus. 2023 Jul 11;15(7):e41712. doi: 10.7759/cureus.41712. eCollection 2023 Jul.
A 10-year-old child presented to eye casualty with pain, watering and photophobia of the left eye for one month. Parents gave a history of chuna (lime) falling inside the eye one month back, following which the patient consulted at a primary health centre. However, there was no relief of symptoms and the patient was referred to a higher centre. On examination under anaesthesia, the eye was full of chuna particles. Removal of all visible chuna particles and the corneal chuna plaque was planned. Intra-operatively, the stromal melt was noted around the corneal chuna plaque extending up to Descemet's membrane. Microscope-integrated optical coherence tomography (Mi-OCT) guided removal of corneal chuna particles was done. A tectonic deep anterior lamellar keratoplasty (DALK) along with amniotic membrane graft (AMG) and symblepharon ring placement was done. Two weeks post-operatively, the patient was having a persistent epithelial defect. A repeat AMG with a symblepharon ring was done. On one month follow-up, the epithelial defect had healed. This case emphasises the fact that ocular chemical injuries are an emergency requiring urgent and apt management. In cases of severe ocular chuna injury with delayed presentation, removal of all particles, maintenance of globe integrity and ocular surface restoration is a challenging goal. Healing is slow and visual prognosis is generally guarded in such cases.
一名10岁儿童因左眼疼痛、流泪和畏光1个月就诊于眼科急诊。家长称1个月前有石灰落入眼内，之后患者在基层医疗中心就诊。然而，症状并未缓解，患者被转诊至上级中心。在麻醉下检查时，眼内充满石灰颗粒。计划清除所有可见的石灰颗粒和角膜石灰斑。术中，注意到角膜石灰斑周围的基质溶解延伸至后弹力层。在显微镜集成光学相干断层扫描（Mi-OCT）引导下清除角膜石灰颗粒。进行了结构性深板层角膜移植术（DALK），同时植入羊膜移植片（AMG）并放置睑球粘连环。术后两周，患者持续存在上皮缺损。再次进行了AMG并放置睑球粘连环。在1个月的随访中，上皮缺损已愈合。该病例强调了眼化学伤是一种需要紧急和恰当处理的急症这一事实。在严重的眼石灰伤且就诊延迟的病例中，清除所有颗粒、维持眼球完整性和恢复眼表是一个具有挑战性的目标。此类病例愈合缓慢，视力预后通常不佳。
