|Title||Is it time to consider new treatments for ocular chemical burns?|
|Submitted by||Romeela Rana-Rahman|
|Review Result||rapid fire presentation|
To increase the awareness and debate the role of new amphoteric chelating agents as first line treatment of ocular chemical injuries.
A literature review was performed for cases and comparative studies using Hexafluorine and Diphoterine for first line treatment of chemical injuries. Electronic database searches were performed on Ovid-Medline. Studies included were published in peer reviewed journals up to 2017. All papers included alkali burns only and documented chemical injury to the body. Those with delayed treatment (>24 hours) and acid injuries were excluded
This review included 183 cases which described the cutaneous reaction of amphoteric solutions (AS) versus water or saline. There is a reported statistically significant difference in the normalisation of pH post AS use and degree of blisters occuring post diphoterine use versus water (p<0.001). There are only 3 cases in which corneal epithelial loss was assessed. There is evidence that there are better outcomes for faster corneal epithelialisation, which should lead to fewer complications but this has no statistical significance
There is encouraging evidence that the severity of the injury is less when AS are used as a first line agent. This may have an important role in limiting sequelae, including lid burns and stem cell loss; particularly for patients who abscond. This review highlights the need to collect more cases of AS use and the need for a more comparative controlled trial. None of the researchers were blinded in these studies. At minimum a 'blinded' clinician should assesses the degree of ocular injury post AS use versus conventional irrigation. This should include assessment and formal grading of the ocular surface injury and visual outcomes
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