Abstract
Purpose :
Ocular surface keratinization (OSK) as a result of Steven Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) is a severe complication that traditionally has few options for restoration of the ocular surface and visual rehabilitation. This case series explores the use of Vitamin A loaded autologous serum tears (VAAST) to reduce OSK in SJS/TEN.
Methods :
Four eyes of two patients were studied retrospectively to evaluate the efficacy of VAAST in reducing OSK. Visual acuity (VA) and exam findings were reviewed.
Results :
For two patients with severe OSK from SJS/TEN, VAAST were prescribed. This was done by having the patients take ten 8000 IU Vitamin A tablets the night before serum blood draw. These serum tears were then self-administered to the ocular surface 4 times a day.
In the first case, a 28-year-old woman had severe keratinization of the entire ocular surface of both eyes (OU) and hand motions (HM) vision OU. She had previously tried non-Vitamin A loaded serum tears with minimal effect (in addition to several other topical and systemic medications). After 2 weeks of use of VAAST, her OSK nearly resolved and lubrication further improved. Her vision improved to counting fingers (CF). She is awaiting limbal stem cell transplantation.
In the second case, a 40-year-old male presented with corneal keratinization, neovascularization, and severe keratopathy and lid margin keratinization OU. His presenting VA was 20/600 OD and 20/300 OS. He underwent mucous membrane grafting of left upper and lower eyelids and right lower eyelid. After 2 weeks of use of VAAST, his OSK nearly resolved (Figure 1). His VA was measured at 20/200 OU. He is currently undergoing optimization of scleral lenses for further visual rehabilitation.
No adverse effects from high dose Vitamin A were observed. No eyes had recurrence of OSK after 2 months of follow up and continued use of VAAST.
Conclusions :
The administration of VAAST can significantly improve OSK and lubrication, improving VA and symptoms, and optimizing the ocular surface for further surgery. While further investigation is needed, this treatment may provide a non-invasive option for treatment in a devastating and blinding disease.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.