Retinal changes and treatment in ocular alkali burn: a systematic review of animal models and case reports summary

This systematic review aimed to characterize pathological retinal changes following ocular alkali burns (OAB), evaluate potential therapeutic interventions to preserve retinal structure and function, and summarize reported human cases with retinal involvement. A systematic search of PubMed, Embase, SCOPUS, and Web of Science, supplemented by manual reference screening, was independently performed by two reviewers in accordance with PRISMA 2020. Eligible studies, human or animal, investigated retinal damage directly attributable to OAB and/or interventions targeting retinal pathology. Screening and selection were performed, with disagreements resolved by consensus. Quality assessment used SYRCLE’s Risk of Bias tool for animal studies and a modified NHLBI tool for case reports. The protocol was registered with PROSPERO (CRD42024598186). A total of 14 studies were included: 12 animal studies and 2 human case reports. Across animal models, seven therapeutic interventions were studied: anti-TNFα, mesenchymal stem cells (MSCs), N-acetylcysteine, tamoxifen, endoplasmic reticulum (ER) stress inhibitors, Solcoseryl gel, and anti-VEGF agents. Infliximab consistently improved retinal ganglion cell (RGC) survival and reduced apoptosis. MSCs, NAC, and TUDCA demonstrated strong anti-inflammatory effects, suppressing cellular infiltration and cytokine expression. ER stress inhibitors and tamoxifen preserved retinal architecture, while Solcoseryl gel offered structural protection but limited anti-inflammatory benefit. Anti-TNFα and anti-VEGF, either alone or in combination, reduced retinal inflammation and RGC loss, whereas anti-VEGF alone showed limited evidence. Among three human case reports, no posterior segment-directed therapies were administered, and visual outcomes ranged from full recovery to persistent vision loss. Retinal injury is a significant but under-recognized consequence of severe OAB. Preclinical studies demonstrate that treatments which offer neuroprotective and anti-inflammatory properties mitigate retinal damage in OAB models. However, clinical evidence remains limited. These findings underscore the importance of early retinal evaluation in OAB and highlight the need for future clinical studies to validate and implement effective treatment strategies. What is known • Ocular alkali burn is a serious injury, especially if inflammation extends to the posterior segment. What is new • Infliximab demonstrated the strongest protective effect in animal models, improving retinal ganglion cell survival and reducing apoptosis. • Bevacizumab and infliximab, alone or in combination, reduced retinal inflammation and loss. • In human case reports, treatments targeting retinal pathology were rarely administered, and visual outcomes varied widely, ranging from full recovery to persistent vision loss.