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Visual Loss In Major Burn Injury After Enzymatic And Surgical Debridement

Juan Javier Garcu00eda-BarreiroA. Fernández-Quinto

出版	Morressier, 2017
URL	http://books.google.com.hk/books?id=j6_HzgEACAAJ&hl=&source=gbs_api

註釋1. ObjectivesReview of an extremely rare complication in a major burn injured patient due to a case: ischemic optic neuropathy (ION).2. MethodsA 37-year-old male with a 85% total body surface burn injury caused by high temperature water vapor with caustic soda was admitted to the Burn Care Unit of our center. He underwent initial volume fluid resuscitation with 27L of Lactate Ringer and needed invasive hemodynamic monitoring due to refractory shock.Escharotomy was needed the day of admission, and sequential enzymatic debridement with bromelain twice and debridement with coverage five times were conducted during hospitalization.After the organ failure and skin coverage being solved, he was extubated on 85 postburn day (PBD).He received ophthalmologic follow-up, with normal intraocular pressure, fundoscopy and anterior pole without alterations.3. ResultsOn 92 PBD the patient complained of blindness. Intraocular pressure was 17mmHg, fundoscopy showed disc pallor; carotid arteries doppler ultrasound and CT scan had no alterations and magnetic resonance showed nonspecific minimal widen of subarachnoid perioptic spaces.Dismissed pharmacologic, compressive and infectious causes, the patient was diagnosed of ischemic optic neuropathy.There is not an effective treatment available and the complication is currently irreversible.4. ConclusionNon-arteritic ION is a rare cause of visual loss due to a decreased blood flow through the optic nerve. It has been described in other groups of postoperatory patients and as a major complication in polytraumatisms that need massive fluid resuscitation, but barely described in burned patients. Currently there is not an effective treatment available for this complication therefore prevention is the principal objective.