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Prompt versus delayed amniotic membrane application in a patient with acute Stevens-Johnson syndrome

Authors Ciralsky JB, Sippel KC

Received 11 March 2013

Accepted for publication 9 April 2013

Published 31 May 2013 Volume 2013:7 Pages 1031—1034

DOI https://doi.org/10.2147/OPTH.S45054

Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 3

Jessica B Ciralsky, Kimberly C Sippel

Department of Ophthalmology, Weill Cornell Medical College, New York, NY, USA

Background: Stevens-Johnson syndrome is often associated with blinding ocular surface cicatricial sequelae. Recent reports have described markedly improved clinical outcomes with the application of amniotic membrane to the ocular surface during the acute phase. Here we describe the clinical outcome of a patient with acute Stevens-Johnson syndrome and severe ocular surface involvement in whom the evolving medical condition and family consent resulted in amniotic membrane application to each eye at differing intervals from disease onset.
Methods: We undertook a retrospective chart review of a woman with Stevens-Johnson syndrome who presented within hours of disease onset. She underwent application of amniotic membrane to the ocular surface of the left eye during the hyperacute phase (<72 hours after disease onset) and to the right eye at a later time point during the acute phase (six days after disease onset). The clinical outcomes of the two eyes, as well as associated ocular symptoms, were compared over a one-year postoperative period.
Results: The right eye, treated later in the course of the disease, required additional surgical procedures and ultimately exhibited significantly more advanced ocular surface pathology than the left. Further, the patient reported more pronounced issues of chronic eye pain and visual difficulties in the right eye.
Conclusion: Earlier intervention with application of amniotic membrane to the ocular surface in this patient with severe ocular involvement secondary to Stevens-Johnson syndrome proved superior. Application of amniotic membrane as soon as possible after disease onset, preferably in the hyperacute phase, appears to result in a significantly better clinical outcome than application later in the disease course.

Keywords: Stevens-Johnson syndrome, toxic epidermal necrolysis, amniotic membrane

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