Total Ocular Surface Coverage with Amniotic Membrane Transplantation in Acute Pediatric Toxic Epidermal Necrolysis: A Retrospective Comparison with Topical Treatments.

Abstract

Purpose : Substantial practice variation exists in the ophthalmologic treatment of the acute toxic epidermal necrolysis (TEN) and Stevens-Johnson syndrome. We tested the hypothesis that amniotic membrane transplantation of the ocular surface would improve eye and vision outcomes in pediatric biopsy-proven TEN. Based on the reports of Gregory and others, we have treated 16 pediatric TEN patients with early (acute phase) amniotic membrane transplantation of the ocular surface.

Methods : In this IRB-approved retrospective review, we identified 16 patients who received amnion in the acute phase of toxic epidermal necrolysis (Amnion), and 6 patients treated without amnion (Topical). For each patient, eye involvement was assessed using magnified exam with fluorescein stain, photography, and review of medical records. We scored patients at two timepoints: initial presentation and post-acute clinic visit (1-3 months after skin slough). At each timepoint, we assessed corneal clarity, visual acuity, conjunctiva status, lid/lash/gland status, and severity of ocular surface symptoms. Each parameter was assigned a score between 0 (normal) and 3 (complete dysfunction). Scores of 1 and 2 represented minor and major abnormalities, respectively. Scores were compared between the Topical and Amnion groups via both parametric (two tailed t-test) and nonparametric (Wilcoxon rank sum test) methods.

Results : On initial presentation, the two groups were comparable for each of the 5 eye score categories, with no statistically-significant differences appreciated. Improved corneal clarity, visual acuity, conjunctiva, and ocular surface symptom scores were observed on post-acute follow-up in the Amnion group compared with the Topical treatment group (Figure 1). Parametric and nonparametric statistical metholodogies were in agreement (Table 1).

Conclusions : In this retrospective series of 22 pediatric TEN patients, significantly improved post-acute (1-3 months) corneal clarity, visual acuity, conjunctiva, and ocular surface symptom scores were observed in the Amnion group, as compared with the Topical treatments only group.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.