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Swapna Shanbhag, James Chodosh, Hajirah Saeed; Long-term outcomes of amniotic membrane transplantation in acute Stevens-Johnson syndrome/ toxic epidermal necrolysis. Invest. Ophthalmol. Vis. Sci. 2018;59(9):1322. doi: https://doi.org/.
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To report the long-term outcomes of amniotic membrane transplantation (AMT) and self-retained amniotic membrane (ProKera device, PD) in acute Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN)
Electronic records were reviewed of all patients with a diagnosis of SJS/TEN at MEEI between January 2008 and June 2017. Patients who received AMT (amniotic membrane covering the eyelids and the entire ocular surface) or a PD (amniotic membrane retained in a symblepharon ring, covering the cornea and limbal conjunctiva) in the acute phase of SJS/TEN were selected. Only patients with follow-up ≥ 6 months after AMT or PD were included.
Data of 43 eyes of 23 patients who had severe ocular involvement in the acute phase of SJS/TEN and received AMT or a PD in the acute phase were analyzed. Mean age of the patients was 30.3 years (range: 6-69 years). All 43 eyes received either AMT or PD at a median period of 6 days (range: 2-18 days) after the onset of skin rash. Forty-four percent (19/43) eyes received AMT while 56% (24/43) eyes received a PD. Out of the 19 eyes in the AMT group, 4 eyes received a repeat AMT after dissolution of the initial AM, while 6/19 eyes received a subsequent PD. Out of the 24 eyes in the PD group, 6 eyes received a repeat PD after dissolution of amnion in the original PD. Median follow-up after initial AMT or PD was 29.9 months (range: 6-101 months). At last follow-up, the best-corrected visual acuity was ≥ 20/40 in 91% (39/43) eyes. The most common chronic sequelae were meibomian gland disease (74.4%, 32/43 eyes), lid margin keratinization (58.1%, 25/43 eyes), tarsal conjunctival scarring (46.5%, 20/43 eyes), and trichiasis (44.2%, 19/43 eyes). Thirty percent (12/43) eyes were fitted with a prosthetic replacement of the ocular surface ecosystem (PROSE) device. The PROSE device was being used in all 12 eyes at last follow-up visit. Nineteen percent (8/43) eyes had severe lid margin keratinization in the chronic phase and underwent lid margin mucous membrane grafting. Six of these eyes had received a PD only in the acute phase.
Early use of amniotic membrane in the acute phase of SJS/TEN is effective at maintaining visual acuity in the chronic phase. However, lid-related complications remain a common problem even with the use of amniotic membrane. Long-term follow-up in this patient population is of utmost importance.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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