Clinical outcomes and safety of Diphoterine(®) irrigation for chemical eye injury: A single-centre experience in the United Kingdom

PURPOSE: Diphoterine(®) is an amphoteric irrigating solution armed with rapid pH-neutralising action. It serves as an effective first-aid treatment for managing chemical burns, including chemical eye injury (CEI). However, its use is not widely adopted in current clinical practice, primarily attributed to limited clinical evidence. This study aims to highlight the experience in using Diphoterine for managing CEI in a UK tertiary referral centre. METHODS: This retrospective case series included all patients who presented with CEI and treated with Diphoterine at the James Cook University Hospital, UK, between April 2018 and February 2020. RESULTS: Seven patients (10 eyes) were included; the mean age was 28.2 ± 17.0 years (ranged, 3–70 years) and 85.7% were male. All patients presented with an alkaline injury with a mean presenting pH of 8.7 ± 0.7 and a median (±interquartile range [IQR]) corrected-distance visual acuity (CDVA) of 0.10 ± 0.28 logMAR. Based on Roper-Hall classification, 90% and 10% of the eyes were of grade-I and -IV CEI, respectively. All eyes received normal saline/water as the first irrigation fluid and Diphoterine as second irrigation fluid. The mean pH improved slightly after first irrigation (8.4 ± 0.7; p = 0.13) and significantly after second irrigation (7.6 ± 0.4; p = 0.001). The volume of irrigation used was significantly less for Diphoterine (520 ± 193 mL) than for normal saline/water (2700 ± 2451 mL; p = 0.016). At final follow-up (median = 5 days), the median CDVA remained stable at 0.10 ± 0.28 logMAR (p = 0.60). One patient developed near-total limbal stem cell deficiency as a complication of grade-IV injury and was awaiting limbal stem cell transplantation at last follow-up. CONCLUSION: This study represents the first case series in the United Kingdom, reporting the use of Diphoterine in managing CEI. The rapid pH-neutralising action of Diphoterine, with less volume required, makes it an ideal initial treatment for efficiently managing adult and paediatric patients with CEI in clinics.