Management of alkali burns : an 11-year retrospective review.
OBJECTIVE
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.


METHODS
Retrospective nonrandomized comparative study.


METHODS
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.


METHODS
Time to corneal reepithelialization, final best-corrected visual acuity, and time to visual recovery, length of hospital stay, and complications were analyzed.


RESULTS
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.


CONCLUSIONS
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.
Brodovsky
S C
SC
Centre for Eye Research Australia, Department of Ophthalmology, University of Melbourne, Melbourne, Victoria, Australia.
McCarty
C A
CA
Snibson
G
G
Loughnan
M
M
Sullivan
L
L
Daniell
M
M
Taylor
H R
HR
D000287:Administration, Topical; D000328:Adult; D000468:Alkalies / Q000009:adverse effects*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001205:Ascorbic Acid / Q000627:therapeutic use; D002057:Burns, Chemical / Q000145:classification / Q000188:drug therapy* / Q000503:physiopathology; D019343:Citric Acid / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D019573:Epithelium, Corneal / Q000187:drug effects / Q000502:physiology; D005126:Eye Burns / Q000139:chemically induced* / Q000145:classification / Q000188:drug therapy / Q000503:physiopathology; D005260:Female; D005938:Glucocorticoids; D006782:Hospitals, Special; D006801:Humans; D008297:Male; D009517:New South Wales; D009883:Ophthalmic Solutions / Q000627:therapeutic use*; D009885:Ophthalmology; D012189:Retrospective Studies; D016896:Treatment Outcome; D014945:Wound Healing / Q000187:drug effects
D000468:Alkalies; D000900:Anti-Bacterial Agents; D000893:Anti-Inflammatory Agents; D005938:Glucocorticoids; D009883:Ophthalmic Solutions; D019343:Citric Acid; D001205:Ascorbic Acid