Chemical Burns of the Eye: The Role of Retinal Injury and New Therapeutic Possibilities. Issue 2 (February 2018)

• Record Type: Journal Article
• Authors: Dohlman, Claes H.; Cade, Fabiano; Regatieri, Caio V.; Zhou, Chengxin; Lei, Fengyang; Crnej, Alja; Harissi-Dagher, Mona; Robert, Marie-Claude; Papaliodis, George N.; Chen, Dongfeng; Aquavella, James V.; Akpek, Esen K.; Aldave, Anthony J.; Sippel, Kimberly C.; D'Amico, Donald J.; Dohlman, Jan G.; Fagerholm, Per; Wang, Liqiang; Shen, Lucy Q.; González-Andrades, Miguel; Chodosh, James; Kenyon, Kenneth R.; Foster, C. Stephen; Pineda, Roberto; Melki, Samir; Colby, Kathryn A.; Ciolino, Joseph B.; Vavvas, Demetrios G.; Kinoshita, Shigeru; Dana, Reza; Paschalis, Eleftherios I.;
• Is Part Of: Cornea. Volume 37:Issue 2(2018)
• Publication Date: 2018-02
• Subjects: chemical burns -- tumor necrosis factor alpha -- infliximab -- retinal protection -- glaucoma -- keratoprosthesis; Cornea -- Periodicals; Cornea -- Periodicals; Cornée -- Périodiques; 617.719
• DOI: 10.1097/ICO.0000000000001438
• Languages: English
• ISSNs: 0277-3740

Abstract

Abstract : 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.