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Severe ocular alkali injury managed with an externally sutured amniotic membrane and customized symblepharon ring

1 Department of Medical Education, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
2 Department of Ophthalmology, Wills Eye Hospital, Philadelphia PA, USA
3 Department of Ophthalmology, Wills Eye Hospital; Cornea Service, Wills Eye Hospital, Philadelphia, PA, USA

Correspondence Address:
Christopher J Rapuano,
Department of Ophthalmology, Wills Eye Hospital, 840 Walnut Street, Suite 920, Philadelphia, PA 19107
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2211-5056.362597

Alkali injuries are ocular emergencies that require immediate evaluation and therapy to preserve vision. Severe alkali injuries can result in long-term vision-threatening sequelae including symblepharon, corneal ulceration, corneal scarring, limbal stem cell deficiency, xerophthalmia, cicatricial changes of the eyelid and adnexa, glaucoma, uveitis, and permanent vision loss. Treatment is aimed at neutralizing the pH, controlling inflammation, and restoring the ocular surface. Here, we present the case of a 35-year-old male who sustained direct ocular exposure to sodium hydroxide, resulting in significant corneal and conjunctival epithelial defects despite aggressive initial medical therapy. The patient subsequently received a large, externally sutured amniotic membrane (AM) with a customized symblepharon ring to promote healing. The corneal and conjunctival defects resolved, and at 4 months after the initial injury, the patient's visual acuity had improved to 20/25. Clinicians should be aware of the various surgical techniques to place an AM transplantation and identify the best strategy based on clinical findings and the extent and severity of the injury.

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