Authors: Yelin Yang, Hall Chew, Kamiar Mireskandari, Simon Fung, Asim Ali
Author Disclosure Block: Y. Yang: None. H. Chew: None. K. Mireskandari: Membership on advisory boards or speakers’ bureaus; Santen Inc. S. Fung: None. A. Ali: Membership on advisory boards or speakers’ bureaus; Santen Inc.

Abstract Body:

Purpose: In patients with Stevens-Johnson syndrome (SJS) /toxic epidermal necrolysis (TEN), the ocular surface is markedly inflamed in the acute setting which can lead to significant long-term sequelae. Early use of amniotic membrane transplantation (AMT) suppresses inflammation and promotes healing in these patients. This study aims to review the Toronto experience of AMT among patients with acute ocular SJS/TEN.
Study Design: Multicentre consecutive case series
Methods: Patients who underwent AMT for ocular SJS/TEN at the Hospital for Sick Children and Sunnybrook Health Sciences Centre between 2010 and 2018 were included in the study. Outcomes and clinical data including best-corrected visual acuity (BCVA), ocular surface and lid abnormalities including trichiasis, distichiasis, lid keratinization, tarsal scarring, entropion, symblepharon, superficial punctal keratitis/epithelial defect and limbal stem cell deficiency (LSCD) were analyzed.
Results: Thirty-two eyes of 16 patients (9 adult, 7 paediatric) were included in the study with median follow up of 33 months (range 4 months to 9 years). Of these patients, 62% (10/16) were male and the mean age was 24.4 years. The median number of days between diagnosis and AMT was 3 (range 1 to 30), where 14 patients received AMT within 7 days of diagnosis. Preoperatively, BCVA was worse than 20/200 in 8/16 eyes with available data. The majority of patients had severe ocular involvement, including conjunctival injection (32/32 eyes), corneal epithelial defect (26/32) symblepharon formation (24/32) and pseudomembranous conjunctivitis (20/32). Complications, and the median time to the complication, were as follows: lid margin keratinization (26/32, 3 months), symblepharon (18/32, 1.5 month), tarsal conjunctival scarring (16/32, 2 months), trichiasis (12/32, 2 months), distichiasis (9/32, 10 months), lid entropion (7/32, 3 months) and LSCD (7/32, 5 months). All adult patients had evidence of lid keratinization, while pediatric patients had proportionally higher rate of entropion (7 eyes) and LSCD (5 eyes). At last follow up, 21/32 of eyes had BCVA ≥20/40, while vision in the remaining 11 eyes was limited mostly due to corneal scarring,LSCD or poor compliance with treatment. Two patients that had delayed AMT at 13 and 30 days respectively had poorer visual outcome and developed significant LSCD. Three patients in the pediatric group required entropion repair within the first year.
Conclusions: AMT is an effective treatment for stabilizing the ocular surface during the acute phase of SJS/TEN. However, chronic ocular sequelae can still occur in long term and require close monitoring.