Amniotic membrane may protect ocular surface in toxic epidermal necrolysis

TINLEY PARK, Ill. — Amniotic membrane transplantation may prevent vision loss and severe damage to the ocular surface resulting from acute toxic epidermal necrolysis, according to a surgeon here.

Toxic epidermal necrolysis is an autoimmune disorder affecting mucus membranes of the body and is usually accompanied by severe ocular involvement. Thomas John, MD, clinical associate professor with Loyola University Medical Center, said patients with ocular involvement of the disease often will lose vision over time, even with traditional therapies.

Additionally, if not treated effectively, patients will have other ongoing ocular problems, such as severe dry eye, entropion, corneal clouding and corneal ulceration. Classic treatment for the ocular complications of acute toxic epidermal necrolysis involves using a glass rod to break adhesions between the eyelids and the globes. Lubricating eye drops or gels are also used to coat the ocular surface.

Dr. John and colleagues transplanted the amniotic membrane into two children with acute toxic epidermal necrolysis. He told Ocular Surgery News he would recommend membrane transplants only for patients with the acute phase of the disease. Close follow-up is mandatory to ensure the ocular surfaces remain covered, because the disease may cause the membrane to dissolve.

In Dr. John’s first case, a 6-year-old patient developed epidermal necrolysis after oral administration of trimethoprim and sulfamethoxazole (Septra, Glaxo Wellcome). Dr. John used amniotic membrane to line the entire ocular surface and eyelids. He said the amniotic membrane prevented tissue adhesion and damage to the conjunctival tissue common with the disease progression.

Thirty-six months after bilateral surgery, the patient had no symblepharon and maintained good ocular surface wetting. After almost 6 years of follow-up, Dr. John said the patient has retained his 20/20 uncorrected visual acuity.

More about the disease and this study can be found in the upcoming April 15 issue of Ocular Surgery News.