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Samantha Herretes, Abdourahman Cham, Matthew Cossack, Erin Stahl; Amniotic Membrane Transplantation for Ocular Involvement in Mycoplasma Induced Rash and Mucositis. Invest. Ophthalmol. Vis. Sci. 2017;58(8):3943.
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Mycoplasma-induced rash and mucositis (MIRM) has been recently described as a clinical entity separate from Stevens Johnson Syndrome (SJS), Toxic Epidermal Necrolysis (TEN), and Erythema Multiforme (EM). It typically affects younger patients and tends present with severe mucositis affecting eyes, mouth, and genital area, but with sparse cutaneous involvement and good prognosis with rare mortality. While amniotic membrane transplantation (AMT) guidelines have been used for ocular involvement in SJS, its use in MIRM hasn’t been evaluated. We performed a retrospective evaluation of patients with a diagnosis of MIRM with ocular involvement that underwent AMT.
We evaluated patients under 18 years of age with a diagnosis of MIRM (as determined by dermatology) with significant unilateral or bilateral eye involvement, who underwent AMT with cryopreserved membrane onto the ocular surface between the years of 2010 and 2016 at a single institution. . A comprehensive pre-operative ocular surface evaluation was performed, including including visual acuity (VA), corneal and conjunctival fluorescein staining, and evaluation of eyelids. Post-operative parameters included VA, surface staining, presence of chronic dry eye, and need for topical anti-inflammatory medications.
Six patients (twelve eyes) were included in the analysis. All patients were within the first 10 days of disease, and had significant conjunctival epithelial defects or eyelid margin skin defects, with or without corneal involvement. Mean pre-operative VA was 20/30. The last follow-up visit ranged from 6months to 4 years. Mean post-operative VA at the last follow-up visit was 20/20. At that time, only one of the patients showed signs of chronic dry eye, which was controlled by the use of topical cyclosporine.
Even though patients with MIRM typically have little to no skin involvement, it is important to emphasize that they can present with intense mucositis and severe inflammation of the ocular surface. AMT has been shown to improve visual outcomes in patients with SJS; however, its efficacy in patients with MIRM hasn’t been established. This study shows that patients with ocular involvement from MIRM may also benefit from AMT when used under the same guidelines previously described for SJS.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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