Managing ocular sequelae after amniotic membrane transplantation ‘paramount’
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Cornea and eyelid margin complications were common after amniotic membrane transplantation for acute manifestations of Stevens-Johnson syndrome/toxic epidermal necrolysis, according to a speaker.
“Even with early use of amniotic membrane transplantation, dry eye disease remains common in patients with SJS/TEN,” Tatiana S. Zanganeh, MD, said at the virtual American Academy of Ophthalmology annual meeting. “Many efforts have been made to intervene early and aggressively with amniotic membrane transplantation, but the management of chronic sequelae is just as paramount.”
In a retrospective chart review spanning January 2006 through January 2020 of all patients admitted to Brooke Army Medical Center, Texas, with dermatologic and histopathologic confirmation of SJS/TEN treated with ocular amniotic membrane transplantation, researchers identified 102 eyes of 52 patients to include in the study. Median time to first transplantation was 5 days after onset of symptoms, and 64% of eyes required repeat transplantations.
Twenty patients (39 eyes) were followed up for more than 2 months after initiation of first transplantation. Of these, best corrected visual acuity was 20/40 or better in 29 eyes, worse than 20/40 but better than 20/200 in five eyes, and 20/200 or worse in five eyes.
The most common ocular complication at follow-up involved the cornea and the eyelid margin, whereas there was a statistically significant improvement in the number of eyes with conjunctival and eyelid skin involvement (P < .005), Zanganeh said.
Mechanisms for increased dry eye disease include aqueous tear deficiency, decreased wettability of the corneal surface and increased evaporative loss, which “should be managed by a cornea or dry eye specialist who has an extensive knowledge of the available treatment options,” Zanganeh said.
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Zanganeh TS. Retrospective outcomes of amniotic membrane transplantation in the acute management of patients with SJS and TEN. Presented at: American Academy of Ophthalmology annual meeting; Nov. 13-15, 2020 (virtual meeting).
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