J Korean Ophthalmol Soc.  2010 Jul;51(7):1010-1015. 10.3341/jkos.2010.51.7.1010.

A Case of Alkali Burn Treated With Amniotic Membrane Graft and Forniceal Reconstruction

• Han JM
• Choi HJ
• Wee WR
• Lee JH
• Kim MK

• KMID: 2213792
• DOI: http://doi.org/10.3341/jkos.2010.51.7.1010

Abstract

PURPOSE
To report a case of alkali burn treated successfully with early surgical intervention including amniotic membrane graft and forniceal reconstructionand the restored visual acuity.
CASE SUMMARY
A 23-year-old woman was referred for alkali burn of her right eye after being splashed with a drop of 40% sodium hydroxide. Slit-lamp microscopic examination showed the patient's cornea was edematous, and hazy and limbal ischemia involved half of the cornea, which can supposedly lead to eyelid deformity and symblepharon. Debridement of all necrotic tissues, immediate amniotic membrane permanent graft and transient forniceal covering with amniotic membrane were conducted a day after the burn. Corneal and conjunctival epithelial defects were completely healed in five weeks, and visual acuity was restored to 20/20 in eight weeks. Additional surgeries for allogenic limbal transplantation and autologous oral mucosal graft were performed to resolve symblepharon.

Keyword

Alkali burn; Amniotic membrane graft; Forniceal reconstruction; Debridement

MeSH Terms

Alkalies
Amnion
Burns
Congenital Abnormalities
Cornea
Debridement
Eye
Eyelids
Female
Humans
Hydroxides
Ischemia
Sodium Hydroxide
Transplants
Visual Acuity
Young Adult
Alkalies
Hydroxides
Sodium Hydroxide

Figure

• 

  Figure 1. Slit lamp photographs. (A) Diffuse stromal edema with haziness. Note a limbal capillary ischemic change. More than half of the limbal area is ischemic. (B) Slit view shows stromal edema prominent in the inferior area. (C) Fluorescein staining reveals nearly total epithelial defect.

• 

  Figure 2. Schematic illustration of forniceal reconstruction with amniotic membrane graft. (A) Two amniotic membrane, 4 cm×5 cm in size, were sutured to one (4 cm×10 cm) to cover the whole bulbar and tarsal conjunctiva. (B) Sutured amniotic membrane was fixed to both eyelid margins. (C) Additional suture around the perilimbal area was done to fix redundant amniotic membrane more tight. (D) Silicone band was cut and anchored to upper and lower conjunctival fornices. (E) Sutures passed through fornices and skin bolsters, and then tied knots on each bolster.

• 

  Figure 3. Photographs of operation procedure. (A) After necrotic tissue removal, permanent amniotic membrane graft is applied onto the defective area. (B) Another amniotic membrane which was doubled in size was covered over the whole cornea and bulbar and tarsal conjunctiva, thereafter it is fixed to both eyelid margins with continuous sutures. (C) Continuous suture around perilimbal area was added to fit amniotic membrane tight. (D) A silicone band is inserted to deepen both fornices over the amniotic membrane, which supports the amniotic membrane to stay tight on both inflamed tarsal and bulbar conjunctiva.

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  Figure 4. Follow-up photograph at 8 weeks after alkali burn. It demonstrates that corneal and conjunctival epithelial defect is completely healed and stromal opacity is markedly diminished.

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  Figure 5. Follow-up photograph at 4 months after alkali burn. Note symblepharon and pseudopterygium on the nasal side of her cornea.

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  Figure 6. Photograph at 4 months after limbal transplantation, mucosal graft, and forniceal reconstruction. Symblepharon is cured and cornea is clearly maintained.

Reference

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