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Rashad R, Kwan JT, Shanbhag SS, Ngowyutagon P, Saeed M, Tahboub MA, Haseeb A, Chodosh J, Saeed HN. Long-term outcomes of glued (sutureless) amniotic membrane transplantation in acute Stevens-Johnson syndrome/toxic epidermal necrolysis: a comparative study. Br J Ophthalmol 2024:bjo-2023-324076. [PMID: 38490716 DOI: 10.1136/bjo-2023-324076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 03/03/2024] [Indexed: 03/17/2024]
Abstract
PURPOSE To compare the effectiveness and efficiency of a glued (sutureless) technique for amniotic membrane transplantation (AMT) with a traditional sutured one in the setting of acute Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN). METHODS This retrospective cohort study evaluated all patients diagnosed with SJS/TEN between 2008 and 2020 within our hospital network who received AMT in the acute phase according to our protocol and had at least one ophthalmic follow-up in the chronic phase. Primary outcomes included best-corrected visual acuity (BCVA) at the most recent visit, presence of a severe ocular complication (SOC) via predefined criteria, time to procedure and duration of procedure. Random effects model analysis was used to evaluate the impact of potential covariates on outcome measures. RESULTS A total of 23 patients (45 eyes) were included: 14 patients (27 eyes) in the AMT suture group and 9 patients (18 eyes) in the AMT glue group. There was no difference between the two groups in BCVA at the most recent visit (p=0.5112) or development of a SOC (p=1.000). The glue method was shorter in duration than the suture method (p<0.001). Random effects model additionally indicated that there was no difference in BCVA at most recent follow-up between patients who had received glued versus sutured AMT (p=0.1460). CONCLUSIONS Our glued technique for AMT is as effective as our sutured technique in stabilising the ocular surface and mitigating chronic ocular complications in SJS/TEN. The glued technique is also shorter in duration and performed more expediently than the sutured technique.
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Affiliation(s)
- Ramy Rashad
- Department of Ophthalmology, Boston Medical Center, Boston, Massachusetts, USA
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - James T Kwan
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
- Department of Ophthalmology, New England Eye Center, Boston, Massachusetts, USA
| | - Swapna S Shanbhag
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
- The Cornea Institute, L.V. Prasad Eye Institute, Hyderabad, Telangana, India
| | - Panotsom Ngowyutagon
- Department of Ophthalmology, Mahidol University, Salaya, Thailand
- Department of Ophthalmology, Illinois Eye and Ear Infirmary, University of Illinois Chicago, Chicago, Illinois, USA
| | - Musa Saeed
- Department of Ophthalmology, Illinois Eye and Ear Infirmary, University of Illinois Chicago, Chicago, Illinois, USA
| | - Mohammad A Tahboub
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Abid Haseeb
- Department of Ophthalmology, Illinois Eye and Ear Infirmary, University of Illinois Chicago, Chicago, Illinois, USA
| | - James Chodosh
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
- Division of Ophthalmology, University of New Mexico, Albuquerque, New Mexico, USA
| | - Hajirah N Saeed
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
- Department of Ophthalmology, Illinois Eye and Ear Infirmary, University of Illinois Chicago, Chicago, Illinois, USA
- Department of Ophthalmology, Loyola University Medical Center, Maywood, IL, USA
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2
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Lin CW, Wang JJ, Lai CH, Wu PL. Sutureless amniotic membrane (ProKera®) in the management of symblepharon after Steven-Johnson syndrome: A case report. J Fr Ophtalmol 2024; 47:104005. [PMID: 38016870 DOI: 10.1016/j.jfo.2023.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 08/16/2023] [Accepted: 09/18/2023] [Indexed: 11/30/2023]
Affiliation(s)
- C-W Lin
- Department of Medical Education, Chang Gung Memorial Hospital, 61363 Chiayi, Taiwan; Department of Ophthalmology, Chang Gung Memorial Hospital, 61363 Chiayi, Taiwan
| | - J-J Wang
- Department of Ophthalmology, Chang Gung Memorial Hospital, 61363 Chiayi, Taiwan
| | - C-H Lai
- Department of Ophthalmology, Chang Gung Memorial Hospital, 61363 Chiayi, Taiwan; Department of Medicine, Chang Gung University, 33302 Taoyuan, Taiwan; Department of Nursing, Chang Gung University of Science and Technology, 61363 Chiayi, Taiwan; School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, 33302 Taoyuan, Taiwan
| | - P-L Wu
- Department of Ophthalmology, Chang Gung Memorial Hospital, 61363 Chiayi, Taiwan; Department of Medicine, Chang Gung University, 33302 Taoyuan, Taiwan.
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3
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Zhang N, Geng X, Liu R, Liu X, Cui H, Dou R, Hou S, Li J, Zhu L, Li Z. Novel technique for amniotic membrane transplantation for acute Stevens-Johnson syndrome/toxic epidermal necrolysis patients. Heliyon 2023; 9:e18853. [PMID: 37600383 PMCID: PMC10432697 DOI: 10.1016/j.heliyon.2023.e18853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 07/27/2023] [Accepted: 07/31/2023] [Indexed: 08/22/2023] Open
Abstract
Purpose To report a novel technique to facilitate amniotic membrane transplantation (AMT) for acute stage Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). Design Laboratory investigation and retrospective, single-center case series. Methods The polylactic acid (PLA) amniotic fornical ring (AFR) have been successfully manufactured by three-dimensional (3D) printing technology for AMT. This study retrospectively analyzed the medical records of 5 SJS/TEN patients at the acute stage between 2019 and 2023. Patients were surgically treated with AFR or sutured amniotic membrane transplant (SAMT). Epidemiology, best-corrected visual acuity (BCVA), acute ocular severity score, operative duration, epithelial healing time, amniotic dissolution and follow-up time were evaluated. Results Of all five patients, three patients (6 eyes) received AFR/AMT (Group A), and 2 patients (4 eyes) received SAMT (Group B). There were no significant differences between two groups in the mean preoperative days and vision changes. The mean operation duration was 11.7 ± 3.8 mins in group A. Compared with the SAMT (48.8 ± 5.3 mins), the operation duration was reduced by 76.02%. The mean times for epithelial healing were 32.5 ± 29.2 days in group A and 12.0 ± 0.0 days in group B. In addition, there were no significant side effects of 3D-printed sterile AFR on the eyes. Conclusions 3D-printed PLA scaffolds could be used as an AFR device for acute SJS/TEN. In addition, personalized 3D-printed AFR is superior to conventional SAMT in operation duration.
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Affiliation(s)
| | | | - Ruixing Liu
- Henan Eye Hospital, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, 450003, China
| | - Xiaowu Liu
- Henan Eye Hospital, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, 450003, China
| | - Haohao Cui
- Henan Eye Hospital, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, 450003, China
| | - Runan Dou
- Henan Eye Hospital, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, 450003, China
| | - Songlin Hou
- Henan Eye Hospital, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, 450003, China
| | - Jingguo Li
- Henan Eye Hospital, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, 450003, China
| | - Lei Zhu
- Henan Eye Hospital, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, 450003, China
| | - Zhanrong Li
- Henan Eye Hospital, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, 450003, China
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4
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Hofmann N, Rennekampff HO, Salz AK, Börgel M. Preparation of human amniotic membrane for transplantation in different application areas. FRONTIERS IN TRANSPLANTATION 2023; 2:1152068. [PMID: 38993896 PMCID: PMC11235369 DOI: 10.3389/frtra.2023.1152068] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 04/20/2023] [Indexed: 07/13/2024]
Abstract
The human amniotic membrane (hAM) is the inner layer of the placenta and plays protective and nutritional roles for the fetus during pregnancy. It contains multiple growth factors and proteins that mediate unique regenerative properties and enhance wound healing in tissue regeneration. Due to these characteristics hAM has been successfully utilized in ophthalmology for many decades. This material has also found application in a variety of additional therapeutic areas. Particularly noteworthy are the extraordinary effects in the healing of chronic wounds and in the treatment of burns. But hAM has also been used successfully in gynecology, oral medicine, and plastic surgery and as a scaffold for in vitro cell culture approaches. This review aims to summarize the different graft preparation, preservation and storage techniques that are used and to present advantages and disadvantages of these methods. It shows the characteristics of the hAM according to the processing and storage methods used. The paper provides an overview of the currently mainly used application areas and raises new application possibilities. In addition, further preparation types like extracts, homogenates, and the resulting treatment alternatives are described.
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Affiliation(s)
- Nicola Hofmann
- German Society for Tissue Transplantation (DGFG) gGmbH, Hannover, Germany
| | - Hans-Oliver Rennekampff
- Klinik für Plastische Chirurgie, Hand- und Verbrennungschirurgie, Rhein-Maas Klinikum GmbH, Würselen, Germany
| | | | - Martin Börgel
- German Society for Tissue Transplantation (DGFG) gGmbH, Hannover, Germany
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5
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Zhou TE, Robert MC. Comparing ProKera With Amniotic Membrane Transplantation: Indications, Outcomes, and Costs. Cornea 2022; 41:840-844. [PMID: 34483269 DOI: 10.1097/ico.0000000000002852] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 06/28/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of this study was to compare the outcomes of ProKera versus amniotic membrane transplantation (AMT) in managing ocular surface disease. METHODS This study is a retrospective case series of patients who received either ProKera or sutured AMT for ocular surface disease. Patient demographics, treatment indications, retention time, percentage healed area, changes in visual acuity, and costs to the health care system were analyzed. RESULTS Fourteen patients were identified and analyzed for each group. The main indications for using ProKera and AMT were similar, including corneal ulcer or epithelial defect due to chemical burns, neurotropic state, or herpes zoster keratitis. The average time to dissolution or removal was 24.8 days in the ProKera group, compared with 50.1 days in the AMT group. The average percentage of healed corneal area was 59% for ProKera and 73% for AMT. There was no significant difference between the initial and the final visual acuity within groups and when comparing both groups. In our expense analysis, ProKera had a total cost of 699.00 Canadian dollars (CAD), whereas the cost of suture AMT was 1561.52 CAD. ProKera priced at 11.85 CAD for each percentage healed surface area and at 21.39 CAD for AMT. CONCLUSIONS ProKera allowed for a faster corneal healing than sutured AMT, although its total healed area was less than the latter. Moreover, ProKera is more cost-effective than AMT, thus reducing financial burden to our health care system.
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Affiliation(s)
- Tianwei Ellen Zhou
- Department of Ophthalmology, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec
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6
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Magone MT, Maiberger M, Clayton J, Pasieka H. Vulvovaginal and ocular involvement and treatment in female patients with Stevens-Johnson syndrome and toxic epidermal necrolysis: A review. Int J Womens Dermatol 2022; 7:520-528. [PMID: 35024409 PMCID: PMC8721055 DOI: 10.1016/j.ijwd.2021.08.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/25/2021] [Accepted: 08/26/2021] [Indexed: 10/31/2022] Open
Abstract
Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are serious adverse cutaneous drug reactions, characterized by epidermal detachment and mucous membrane involvement. SJS/TEN is more common in female patients, with unique findings in the ocular and vulvar regions. Early recognition and intervention, as well as long-term follow-up, are crucial to prevent devastating scarring and sequelae. This review examines the vulvar and ocular manifestations of SJS/TEN and describes the current treatment recommendations for female patients, requiring close consultation and collaboration among dermatology, ophthalmology, and gynecology.
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Affiliation(s)
- M Teresa Magone
- Ophthalmology Consult Services Section, National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Mary Maiberger
- Department of Dermatology, Veterans Affairs Medical Center, Washington, DC
| | - Janine Clayton
- Ophthalmology Consult Services Section, National Eye Institute, National Institutes of Health, Bethesda, Maryland.,Office of Research on Women's Health, National Institutes of Health, Bethesda, Maryland
| | - Helena Pasieka
- Uniformed Services University of Health Sciences, Bethesda, Maryland
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7
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Sutureless fixation of amniotic membrane using a soft ring for ocular surface diseases. Int Ophthalmol 2021; 42:1069-1075. [PMID: 34739628 DOI: 10.1007/s10792-021-02092-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 10/21/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE To evaluate the efficacy of sutureless amniotic membrane transplantation using a soft bioavailable ring in the management of ocular surface disorders. METHODS We present a modified technique using a soft, special designed bioavailable ring set (Amnioring) for sutureless amniotic membrane fixation to the ocular surface. A fresh amniotic membrane with a diameter greater than the outside diameter of the ring was folded inwardly over the ring such that the inner side of the ring was covered with the amniotic membrane. The ring was inserted onto the ocular surface. RESULTS The ring was inserted in 4 eyes of 4 consecutive patients with ocular surface disorders. The mean total operating time was 3 min. The ring fixated the amniotic membrane to the bulbar conjunctiva and provided a quick and easy sutureless placement of amniotic membrane. In all cases, pain was significantly relieved. The corneal epithelial defect and inflammation were markedly reduced. CONCLUSIONS This novel ring designed for sutureless placement of amniotic membrane provided very good anatomic and functional outcomes in patients with ocular surface disorders. It is less invasive, less time consuming and allows placement in the office conditions with low cost.
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8
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Mahmood AH, Alharbi AS, Almanea BA, Alsaati AF. Sutureless Amniotic Membrane (ProKera®) and Intravenous Immunoglobulin in the Management of Ocular Complications of Stevens-Johnson Syndrome-Toxic Epidermal Necrolysis Overlap. Cureus 2021; 13:e16989. [PMID: 34540392 PMCID: PMC8422256 DOI: 10.7759/cureus.16989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2021] [Indexed: 11/05/2022] Open
Abstract
PURPOSE To report a case of Stevens-Johnson syndrome-toxic epidermal necrolysis (SJS-TEN) overlap, with severe acute ocular manifestations successfully managed with sutureless Amniotic Membrane device ProKera® (Bio-Tissue, Inc., Miami, FL) and topical steroids, followed by late complications that were successfully managed with intravenous immunoglobulin (IVIG) therapy. OBSERVATIONS A 24-year-old lady, known case of epilepsy, admitted to the burn unit with SJS-TEN overlap attributed to a recent change of her anti-convulsant therapy, with severe ocular manifestations, inability to open both eyes, and poor visual acuity. Early management included intensive topical steroids and lubrication, in addition to the application of a ProKera® device. Despite achieving full epithelialization within two weeks with the improvement of ocular manifestations, the patient presented three weeks later with recurrence of conjunctival epithelial defects, partial ankyloblepharon, and severely dry corneas. These late sequelae were managed with bandage contact lens (BCL) application, intensive topical steroid, and lubrication in addition to IVIG therapy. After six cycles of IVIG therapy, ocular manifestations improved significantly and the patient achieved uncorrected visual acuity of 6/9 in both eyes. Conclusion and importance: Existing evidence suggests that the use of IVIG in combination with systemic steroids in the early phase of SJS-TEN can reduce mortality, without affecting the final visual outcome in patients with ocular manifestations. This case highlights the possible role of IVIG therapy alone - without systemic steroids - in managing and preventing long-term ocular complications of SJS-TEN.
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Affiliation(s)
- Abdulhameed H Mahmood
- Ophthalmology, Salmaniya Medical Complex, Manama, BHR
- Ophthalmology, Anterior Segment Division, Prince Sultan Military Medical City, Riyadh, SAU
| | | | | | - Anoud F Alsaati
- Ophthalmology, Anterior Segment Division, Prince Sultan Military Medical City, Riyadh, SAU
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9
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Maqsood S, Elsawah K, Dhillon N, Soliman S, Laginaf M, Lodhia V, Lake D, Hamada S, Elalfy M. Management of Persistent Corneal Epithelial Defects with Human Amniotic Membrane-derived Dry Matrix. Clin Ophthalmol 2021; 15:2231-2238. [PMID: 34093006 PMCID: PMC8169046 DOI: 10.2147/opth.s299141] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 04/29/2021] [Indexed: 12/03/2022] Open
Abstract
Objective To report the outcomes of using human amniotic membrane-derived dry matrix (AMDDM) in the management of persistent corneal epithelial defects (PEDs) of various etiologies. Methods A cohort study of 84 patients age range 7 to 92 years with 93 PEDs were treated with AMDDM (Omnigen® using OmniLenz® at two centers (Queen Victoria Hospital and Maidstone Hospital) in the UK. The main outcome measures were healing response of PED and time to heal after application of AMDDM. Results A total of 106 applications of AMDDM were recorded for 81 patients (52 males, 29 females) with a spectrum of different etiologies. Fifty-eight percent of the eyes showed complete healing, and 28% showed partial decrease of the size of PEDs with average treatment length recorded as 22.4±12.3 days. In patients with limbal stem cell deficiency (n=44; aniridia=12, chemical injury=9, Stevens–Johnson syndrome=10), 50% of PEDs showed complete healing and 27% showed partial healing. In patients with microbial keratitis (n=21) (bacterial: 13, fungal: 4, herpetic: 3, acanthamoeba: 1) 57% of PEDs showed complete healing and 33% were partially healed. In patients with keratoplasty (n=16), 56% of PEDs showed complete healing and 31% were partially healed. Vision remained stable in 59% and improved in 27% of the study the population. Conclusion AMDDM can be easily applied in the clinical setting and has demonstrated its efficiency as a new tool to treat persistent epithelial defects.
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Affiliation(s)
- Sundas Maqsood
- Corneo-Plastic Unit, Queen Victoria Hospital NHS, East Grinstead, UK.,Eye Department, Maidstone and Turnbridge Wells Hospitals, Maidstone, UK
| | - Kareem Elsawah
- Cornea Department, Research Institute of Ophthalmology, Giza, Egypt
| | - Navpreet Dhillon
- Corneo-Plastic Unit, Queen Victoria Hospital NHS, East Grinstead, UK
| | - Shady Soliman
- Cornea Department, Research Institute of Ophthalmology, Giza, Egypt
| | - Masara Laginaf
- Eye Department, Maidstone and Turnbridge Wells Hospitals, Maidstone, UK
| | - Vaishali Lodhia
- Eye Department, Maidstone and Turnbridge Wells Hospitals, Maidstone, UK
| | - Damian Lake
- Corneo-Plastic Unit, Queen Victoria Hospital NHS, East Grinstead, UK
| | - Samer Hamada
- Corneo-Plastic Unit, Queen Victoria Hospital NHS, East Grinstead, UK
| | - Mohamed Elalfy
- Corneo-Plastic Unit, Queen Victoria Hospital NHS, East Grinstead, UK.,Eye Department, Maidstone and Turnbridge Wells Hospitals, Maidstone, UK.,Cornea Department, Research Institute of Ophthalmology, Giza, Egypt
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10
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Mimouni M, Trinh T, Sorkin N, Cohen E, Santaella G, Rootman DS, Slomovic AR, Chan CC. Sutureless dehydrated amniotic membrane for persistent epithelial defects. Eur J Ophthalmol 2021; 32:11206721211011354. [PMID: 33887988 DOI: 10.1177/11206721211011354] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE To report outcomes of a sutureless dehydrated amniotic membrane for persistent epithelial defects (PED). METHODS This retrospective study included consecutive patients with a PED (⩾14 days) treated with a sutureless dehydrated amniotic membrane and bandage contact lens (BCL). Included were patients with an epithelial defect that did not respond to treatment with a BCL. Excluded were patients with a follow-up time of less than 3 months. RESULTS Nine eyes of eight patients with a mean age of 54.6 ± 10.9 years (range 38-73 years) were included in this study. The main etiology of the PED was limbal stem cell deficiency (n = 5/9) due to Stevens-Johnson Syndrome (n = 2/5), glaucoma procedures (n = 1/5), graft-versus-host disease (n = 1/5) and severe allergic reaction (n = 1/5). Additional etiologies included neurotrophic cornea (n = 2/9), post keratoplasty and severe dry eye disease (n = 2/9). Time from PED presentation to amnion treatment was 65.9 ± 60.6 days (range 15-189 days) with the area of the PED being 11.0 ± 12.2 mm2 (range 1.0-36.0 mm2). The amnion was absorbed within 2 weeks in 100% of the cases. Following insertion of the amnion, resolution of the PED was achieved in 8/9 eyes (89%) without the need for additional interventions within 17.8 ± 9.6 days (range 7-35 days). LogMAR BCVA improved from 0.94 ± 0.88 to 0.37 ± 0.25 (p = 0.036) with no complications or recurrences recorded. CONCLUSIONS Sutureless dehydrated amniotic membrane achieved resolution of PEDs secondary to various etiologies in 89% of eyes with a significant improvement in vision demonstrated. Further studies are needed to assess long term safety and effectiveness.
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Affiliation(s)
- Michael Mimouni
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada
| | - Tanya Trinh
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada
| | - Nir Sorkin
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada
- Department of Ophthalmology, Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eyal Cohen
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada
| | - Gisella Santaella
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada
| | - David S Rootman
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada
| | - Allan R Slomovic
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada
| | - Clara C Chan
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada
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11
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Chen Z, Lao HY, Liang L. Update on the application of amniotic membrane in immune-related ocular surface diseases. Taiwan J Ophthalmol 2021; 11:132-140. [PMID: 34295618 PMCID: PMC8259520 DOI: 10.4103/tjo.tjo_16_21] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 04/23/2021] [Indexed: 12/18/2022] Open
Abstract
Immune-related ocular surface diseases, a group of diseases in which immune dysregulation damages the ocular surface, can induce uncontrolled inflammation and persistent epithelial defect, thus leading to the most severe forms of acute keratoconjunctivitis, dry eye disease, epithelial keratitis, stromal ulceration, and corneal perforation. As these diseases are often refractory to treatments, they have a threatening impact on the vision and life quality of patients. This review summarizes the current literature regarding the clinical application of sutured and self-retained cryopreserved amniotic membrane (AM) in treating Stevens-Johnson syndrome/toxic epidermal necrolysis, ocular graft-versus-host disease, Sjögren's syndrome, Mooren's ulcer, and peripheral ulcerative keratitis. Current evidence supports the safety and effectiveness of AM, especially self-retained cryopreserved AM, in decreasing ocular surface inflammation, promoting corneal epithelial and stromal healing, improving visual acuity, and preventing sight-threatening complications. Future studies are still required to validate the above findings and explore the varied application methods of AM to improve the clinical efficacy in maintaining ocular surface health.
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Affiliation(s)
- Ziyan Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Hubert Yuenhei Lao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Lingyi Liang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
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12
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Baş Z, Uçakhan Gündüz Ö. Sutureless Amniotic Membrane Transplantation in a Pediatric Patient with Acute Toxic Epidermal Necrolysis. Turk J Ophthalmol 2020; 49:356-360. [PMID: 31893592 PMCID: PMC6961079 DOI: 10.4274/tjo.galenos.2019.13333] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
The purpose of this case report is to describe a new surgical method for sutureless placement of the amniotic membrane with a symblepharon ring in a pediatric patient with acute toxic epidermal necrolysis (TEN). A 1-year-old girl developed severe ocular surface inflammation with large corneal and conjunctival epithelial defects secondary to TEN. She was treated by applying a large (4 cm x 4 cm) amniotic membrane graft and non-sterile symblepharon ring under sedoanalgesia at bedside in the intensive care unit. The ocular surface was completely epithelized by post-treatment week 6 in the right and week 8 in the left eye. Two years after amniotic membrane transplantation, both eyes were quiet with no symblepharon, scar formation, or limbal stem cell deficiency. Performing bilateral amniotic membrane transplantation under a symblepharon ring at bedside provided sufficient acute coverage of the ocular surface and led to excellent clinical outcomes by reducing inflammation and protecting the ocular surface.
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Affiliation(s)
- Zeynep Baş
- Ankara University, Faculty of Medicine, Department of Ophthalmology, Ankara, Turkey
| | - Ömür Uçakhan Gündüz
- Ankara University, Faculty of Medicine, Department of Ophthalmology, Ankara, Turkey
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13
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Thorel D, Ingen-Housz-Oro S, Royer G, Delcampe A, Bellon N, Bodemer C, Welfringer-Morin A, Bremond-Gignac D, Robert MP, Tauber M, Malecaze F, Dereure O, Daien V, Colin A, Bernier C, Couret C, Vabres B, Tetart F, Milpied B, Cornut T, Ben Said B, Burillon C, Cordel N, Beral L, de Prost N, Wolkenstein P, Muraine M, Gueudry J. Management of ocular involvement in the acute phase of Stevens-Johnson syndrome and toxic epidermal necrolysis: french national audit of practices, literature review, and consensus agreement. Orphanet J Rare Dis 2020; 15:259. [PMID: 32962748 PMCID: PMC7510143 DOI: 10.1186/s13023-020-01538-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 09/09/2020] [Indexed: 12/17/2022] Open
Abstract
Stevens-Johnson Syndrome (SJS) and toxic epidermal necrolysis (TEN) can lead to severe ophthalmologic sequelae. The main risk factor is the severity of the initial ocular involvement. There are no recommendations for ocular management during acute phase. We conducted a national audit of current practice in the 11 sites of the French reference center for toxic bullous dermatoses and a review of the literature to establish therapeutic consensus guidelines. We sent a questionnaire on ocular management practices in SJS/ TEN during acute phase to ophthalmologists and dermatologists. The survey focused on ophthalmologist opinion, pseudomembrane removal, topical ocular treatment (i.e. corticosteroids, antibiotics, antiseptics, artificial tear eye drops, vitamin A ointment application), amniotic membrane transplantation, symblepharon ring use, and systemic corticosteroid therapy for ophthalmologic indication. Nine of 11 centers responded. All requested prompt ophthalmologist consultation. The majority performed pseudomembrane removal, used artificial tears, and vitamin A ointment (8/9, 90%). Combined antibiotic-corticosteroid or corticosteroid eye drops were used in 6 centers (67%), antibiotics alone and antiseptics in 3 centers (33%). Symblepharon ring was used in 5 centers (55%) if necessary. Amniotic membrane transplantation was never performed systematically and only according to the clinical course. Systemic corticosteroid therapy was occasionally used (3/9, 33%) and discussed on a case-by-case basis. The literature about ocular management practice in SJS/ TEN during acute phase is relatively poor. The role of specific treatments such as local or systemic corticosteroid therapy is not consensual. The use of preservatives, often present in eye drops and deleterious to the ocular surface, is to be restricted. Early amniotic membrane transplantation seems to be promising.
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Affiliation(s)
- D Thorel
- Département d'Ophtalmologie, CHU Charles Nicolle, F-76000, Rouen, France.,Centre de référence des dermatoses bulleuses toxiques et toxidermies graves TOXIBUL, Créteil, France
| | - S Ingen-Housz-Oro
- Centre de référence des dermatoses bulleuses toxiques et toxidermies graves TOXIBUL, Créteil, France. .,Département de Dermatologie, AP-HP, Hôpital Henri Mondor, 51 avenue du maréchal de Lattre de Tassigny, 94000, Créteil, France. .,EA7379 EpidermE, Créteil, France.
| | - G Royer
- Centre de référence des dermatoses bulleuses toxiques et toxidermies graves TOXIBUL, Créteil, France.,Département d'Ophtalmologie, AP-HP, Hôpital Henri Mondor, Créteil, France
| | - A Delcampe
- Département d'Ophtalmologie, CHU Charles Nicolle, F-76000, Rouen, France.,Centre de référence des dermatoses bulleuses toxiques et toxidermies graves TOXIBUL, Créteil, France
| | - N Bellon
- Centre de référence des dermatoses bulleuses toxiques et toxidermies graves TOXIBUL, Créteil, France.,Département de Dermatologie, AP-HP, Hôpital Necker, Paris, France
| | - C Bodemer
- Centre de référence des dermatoses bulleuses toxiques et toxidermies graves TOXIBUL, Créteil, France.,Département de Dermatologie, AP-HP, Hôpital Necker, Paris, France
| | - A Welfringer-Morin
- Centre de référence des dermatoses bulleuses toxiques et toxidermies graves TOXIBUL, Créteil, France.,Département de Dermatologie, AP-HP, Hôpital Necker, Paris, France
| | - D Bremond-Gignac
- Centre de référence des dermatoses bulleuses toxiques et toxidermies graves TOXIBUL, Créteil, France.,Département d'Ophtalmologie, AP-HP, Hôpital Necker, Paris, France
| | - M P Robert
- Centre de référence des dermatoses bulleuses toxiques et toxidermies graves TOXIBUL, Créteil, France.,Département d'Ophtalmologie, AP-HP, Hôpital Necker, Paris, France
| | - M Tauber
- Centre de référence des dermatoses bulleuses toxiques et toxidermies graves TOXIBUL, Créteil, France.,Département de Dermatologie, CHU Toulouse, Toulouse, France
| | - F Malecaze
- Centre de référence des dermatoses bulleuses toxiques et toxidermies graves TOXIBUL, Créteil, France.,Département d'Ophtalmologie, CHU Toulouse, Toulouse, France
| | - O Dereure
- Centre de référence des dermatoses bulleuses toxiques et toxidermies graves TOXIBUL, Créteil, France.,Département de Dermatologie, Université de Montpellier et INSERM U1058 Pathogenèse et contrôle des infections chroniques, CHU Montpellier, Montpellier, France
| | - V Daien
- Centre de référence des dermatoses bulleuses toxiques et toxidermies graves TOXIBUL, Créteil, France.,Département d'Ophtalmologie, CHU Montpellier, Montpellier, France
| | - A Colin
- Centre de référence des dermatoses bulleuses toxiques et toxidermies graves TOXIBUL, Créteil, France.,Département de Dermatologie, AP-HP, Hôpital Henri Mondor, 51 avenue du maréchal de Lattre de Tassigny, 94000, Créteil, France
| | - C Bernier
- Centre de référence des dermatoses bulleuses toxiques et toxidermies graves TOXIBUL, Créteil, France.,Département de Dermatologie, CHU Nantes, Nantes, France
| | - C Couret
- Centre de référence des dermatoses bulleuses toxiques et toxidermies graves TOXIBUL, Créteil, France.,Département d'Ophtalmologie, CHU Nantes, Nantes, France
| | - B Vabres
- Centre de référence des dermatoses bulleuses toxiques et toxidermies graves TOXIBUL, Créteil, France.,Département d'Ophtalmologie, CHU Nantes, Nantes, France
| | - F Tetart
- Centre de référence des dermatoses bulleuses toxiques et toxidermies graves TOXIBUL, Créteil, France.,Département de Dermatologie, CHU Charles Nicolle, F-76000, Rouen, France
| | - B Milpied
- Centre de référence des dermatoses bulleuses toxiques et toxidermies graves TOXIBUL, Créteil, France.,Département de Dermatologie, CHU Saint-André, Bordeaux, France
| | - T Cornut
- Centre de référence des dermatoses bulleuses toxiques et toxidermies graves TOXIBUL, Créteil, France.,Département d'Ophtalmologie, CHU Pellegrin, Bordeaux, France
| | - B Ben Said
- Centre de référence des dermatoses bulleuses toxiques et toxidermies graves TOXIBUL, Créteil, France.,Département de Dermatologie, Hôpital Edouard Herriot, Lyon, France
| | - C Burillon
- Centre de référence des dermatoses bulleuses toxiques et toxidermies graves TOXIBUL, Créteil, France.,Département d'Ophtalmologie, Hôpital Edouard Herriot, Lyon, France
| | - N Cordel
- Centre de référence des dermatoses bulleuses toxiques et toxidermies graves TOXIBUL, Créteil, France.,Unité de Dermatologie et d'Immunologie clinique, CHU Guadeloupe, Pointe-à-Pitre, Guadeloupe, France
| | - L Beral
- Centre de référence des dermatoses bulleuses toxiques et toxidermies graves TOXIBUL, Créteil, France.,Département d'Ophtalmologie, CHU Guadeloupe, Pointe-à-Pitre, Guadeloupe, France
| | - N de Prost
- Centre de référence des dermatoses bulleuses toxiques et toxidermies graves TOXIBUL, Créteil, France.,Réanimation médicale, AP-HP, Hôpital Henri Mondor, Créteil, France
| | - P Wolkenstein
- Centre de référence des dermatoses bulleuses toxiques et toxidermies graves TOXIBUL, Créteil, France.,Département de Dermatologie, AP-HP, Hôpital Henri Mondor, 51 avenue du maréchal de Lattre de Tassigny, 94000, Créteil, France
| | - M Muraine
- Département d'Ophtalmologie, CHU Charles Nicolle, F-76000, Rouen, France.,Centre de référence des dermatoses bulleuses toxiques et toxidermies graves TOXIBUL, Créteil, France
| | - J Gueudry
- Département d'Ophtalmologie, CHU Charles Nicolle, F-76000, Rouen, France.,Centre de référence des dermatoses bulleuses toxiques et toxidermies graves TOXIBUL, Créteil, France
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14
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Yi S, Huh MI, Hong H, Yoon D, Park HS, Kim DS, Kim HK. Development of Contact Lens-Shaped Crosslinked Amniotic Membranes for Sutureless Fixation in the Treatment of Ocular Surface Diseases. Transl Vis Sci Technol 2020; 9:12. [PMID: 32821509 PMCID: PMC7408872 DOI: 10.1167/tvst.9.6.12] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 03/23/2020] [Indexed: 11/24/2022] Open
Abstract
Purpose To develop a new method of manufacturing contact lens-shaped crosslinked amniotic membranes (AMs) using glutaraldehyde (GA) and dialdehyde starch (DAS) as crosslinking agents. Methods Amniotic membranes were placed on a curved plastic mold and crosslinked with either 4.5% DAS or 1% GA, after which their physical properties and biological safety were evaluated. Results The tensile strength of the GA- and DAS-crosslinked samples was much increased compared with that of normal AMs. Neither crosslinking process affected AM transparency. Although the GA-crosslinked AM showed better enzymatic resistance, its physiological structure was severely damaged after the crosslinking process. On the other hand, compared with the GA-crosslinked AM, the DAS-crosslinked AM showed higher growth factor concentrations and better biocompatibility, similar to normal AMs. In addition, the DAS-crosslinked AM was effective in the recovery of corneal epithelial wounds and was well maintained over 3 days without decentration or degradation on the ocular surface in human subjects. Conclusions Contact lens-shaped AMs were successfully prepared with crosslinking agents. Crosslinking with DAS did not affect the structural properties or biological activity of the AMs, and the improved mechanical properties helped the AM to maintain its curved shape. This crosslinking method allowed us to transplant AMs into patients’ eyes without sutures. Translational Relevance Sutureless fixation of contact lens-shaped AMs would be very convenient and safe for the treatment of corneal surface disease.
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Affiliation(s)
- Soojin Yi
- Bio-Medical Institute, Kyungpook National University Hospital, Daegu, Republic of Korea.,Department of Ophthalmology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Man-Il Huh
- Bio-Medical Institute, Kyungpook National University Hospital, Daegu, Republic of Korea.,Department of Ophthalmology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Hyeonjun Hong
- Department of Mechanical Engineering, Pohang University of Science and Technology (POSTECH), Pohang, Gyeongbuk, Republic of Korea
| | - Donghee Yoon
- Department of Ophthalmology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Han Sang Park
- Department of Ophthalmology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Dong Sung Kim
- Department of Mechanical Engineering, Pohang University of Science and Technology (POSTECH), Pohang, Gyeongbuk, Republic of Korea
| | - Hong Kyun Kim
- Bio-Medical Institute, Kyungpook National University Hospital, Daegu, Republic of Korea.,Department of Ophthalmology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
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15
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Shanbhag SS, Hall L, Chodosh J, Saeed HN. Long-term outcomes of amniotic membrane treatment in acute Stevens-Johnson syndrome/toxic epidermal necrolysis. Ocul Surf 2020; 18:517-522. [PMID: 32200005 DOI: 10.1016/j.jtos.2020.03.004] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 01/21/2020] [Accepted: 03/11/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE To report the long-term outcomes of amniotic membrane (AM) use in the form of transplantation (AMT) and self-retained amniotic membrane (ProKera® device, PD) in acute Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN). METHODS Electronic records of all patients with a diagnosis of SJS/TEN at Massachusetts Eye and Ear between January 2008 and January 2018 were reviewed. Patients who received AM in acute SJS/TEN were selected. Only patients with follow-up ≥ 3 months after discharge were included. RESULTS Data of 55 eyes of 29 patients were analyzed. All 55 eyes received the first AM at a median interval of 5 days (inter-quartile range (IQR): 3-7 days) after onset of skin rash. Fifty-six percent of eyes (31/55) received AMT while 44% (24/55) received PD. Forty percent of eyes (22/55) required a repeat AMT or PD. Median follow-up after initial AM was 2.5 years (IQR: 1.2-3.6 years). At last follow-up, the best-corrected visual acuity was ≥20/40 in 87% of eyes (48/55). The most common complications in the chronic phase were meibomian gland disease and dry eye, seen in 78% of eyes (43/55) and 58% of eyes (32/55) respectively. CONCLUSIONS Long-term results show that early use of AM in the acute phase of SJS/TEN may be effective in mitigating severe vision loss after SJS/TEN. However, eyelid-related complications and dry eye remain a common problem even with the use of AM.
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Affiliation(s)
- Swapna S Shanbhag
- Department of Ophthalmology, Massachusetts Eye & Ear, Boston, MA, USA; The Cornea Institute, L.V. Prasad Eye Institute, Hyderabad, India
| | - Leangelo Hall
- Department of Ophthalmology, Massachusetts Eye & Ear, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - James Chodosh
- Department of Ophthalmology, Massachusetts Eye & Ear, Boston, MA, USA
| | - Hajirah N Saeed
- Department of Ophthalmology, Massachusetts Eye & Ear, Boston, MA, USA.
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16
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Tighe S, Mead OG, Lee A, Tseng SCG. Basic science review of birth tissue uses in ophthalmology. Taiwan J Ophthalmol 2020; 10:3-12. [PMID: 32309118 PMCID: PMC7158924 DOI: 10.4103/tjo.tjo_4_20] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 01/12/2020] [Indexed: 12/31/2022] Open
Abstract
The birth tissue is predominantly comprised of amniotic membrane (AM) and umbilical cord (UC), which share the same cell origin as the fetus. These versatile biological tissues have been used to treat a wide range of conjunctival and corneal conditions since 1940. The therapeutic benefits of the birth tissue stem from its anti-inflammatory and anti-scarring properties that orchestrate regenerative healing. Although the birth tissue also contains many cytokines, growth factors, and proteins, the heavy chain 1-hyaluronic acid/pentraxin 3 (HC-HA/PTX3) matrix has been identified to be a major active tissue component responsible for AM/UC's multifactorial therapeutic actions. HC-HA/PTX3 complex is abundantly present in fresh and cryopreserved AM/UC, but not in dehydrated tissue. In this review, we discuss the tissue anatomy, the molecular mechanism of action based on HC-HA/ PTX3 to explain their therapeutic potentials, and the various forms available in ophthalmology.
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Affiliation(s)
- Sean Tighe
- R&D Department, TissueTech Inc., Miami, Florida, USA
- Department of Ophthalmology, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, USA
- Department of Biochemistry and Molecular Biology, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | - Amy Lee
- R&D Department, TissueTech Inc., Miami, Florida, USA
| | - Scheffer C. G. Tseng
- R&D Department, TissueTech Inc., Miami, Florida, USA
- Ocular Surface Center and Ocular Surface Research Education Foundation, Miami, FL, USA
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17
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Shanbhag SS, Chodosh J, Saeed HN. Sutureless amniotic membrane transplantation with cyanoacrylate glue for acute Stevens-Johnson syndrome/toxic epidermal necrolysis. Ocul Surf 2019; 17:560-564. [PMID: 30872140 DOI: 10.1016/j.jtos.2019.03.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 03/05/2019] [Accepted: 03/05/2019] [Indexed: 12/01/2022]
Abstract
Amniotic membrane (AM) transplantation, when performed in the acute phase in Stevens-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN) for patients with ocular complications, is known to reduce the morbidity of ocular complications in the chronic phase. In conditions such as SJS/TEN, AM needs to be secured to the ocular surface as well as the eyelids. Previously, techniques of securing a large sheet of AM with fibrin glue to the ocular surface and with sutures and bolsters to the eyelids have been described in the acute phase of SJS/TEN. These techniques often necessitate the use of an operating room in acutely ill patients. We describe a bedside technique that uses cyanoacrylate glue to secure the AM to the eyelids, as well as long-term outcomes in 4 patients with acute SJS/TEN. The combination of a custom symblepharon ring to secure AM over the entire ocular surface and cyanoacrylate glue to secure AM to the eyelid margins is quick, painless, does not require local or general anesthesia, and might prove useful in other conditions previously shown to benefit from AMT, such as ocular chemical injuries.
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Affiliation(s)
- Swapna S Shanbhag
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| | - James Chodosh
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| | - Hajirah N Saeed
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA.
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18
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Strategies for reconstructing the limbal stem cell niche. Ocul Surf 2019; 17:230-240. [PMID: 30633966 DOI: 10.1016/j.jtos.2019.01.002] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 10/21/2018] [Accepted: 01/07/2019] [Indexed: 12/19/2022]
Abstract
The epithelial cell layer that covers the surface of the cornea provides a protective barrier while maintaining corneal transparency. The rapid and effective turnover of these epithelial cells depends, in part, on the limbal epithelial stem cells (LESCs) located in a specialized microenvironment known as the limbal niche. Many disorders affecting the regeneration of the corneal epithelium are related to deficiency and/or dysfunction of LESCs and the limbal niche. Current approaches for regenerating the corneal epithelium following significant injuries such as burns and inflammatory attacks are primarily aimed at repopulating the LESCs. This review summarizes and assesses the clinical feasibility and efficacy of current and emerging approaches for reconstruction of the limbal niche. In particular, the application of mesenchymal stem cells along with appropriate biological scaffolds appear to be promising strategies for long-term revitalization of the limbal niche.
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19
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Ziaei M, Greene C, Green CR. Wound healing in the eye: Therapeutic prospects. Adv Drug Deliv Rev 2018; 126:162-176. [PMID: 29355667 DOI: 10.1016/j.addr.2018.01.006] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 10/06/2017] [Accepted: 01/10/2018] [Indexed: 02/07/2023]
Abstract
In order to maintain a smooth optical surface the corneal epithelium has to continuously renew itself so as to maintain its function as a barrier to fluctuating external surroundings and various environmental insults. After trauma, the cornea typically re-epithelializes promptly thereby minimizing the risk of infection, opacification or perforation. A persistent epithelial defect (PED) is usually referred to as a non-healing epithelial lesion after approximately two weeks of treatment with standard therapies to no avail. They occur following exposure to toxic agents, mechanical injury, and ocular surface infections and are associated with significant clinical morbidity in patients, resulting in discomfort or visual loss. In the case of deeper corneal injury and corneal pathology the wound healing cascade can also extend to the corneal stroma, the layer below the epithelium. Although significant progress has been made in recent years, pharmaco-therapeutic agents that promote corneal healing remain limited. This article serves as a review of current standard therapies, recently introduced alternative therapies gaining in popularity, and a look into the newest developments into ocular wound healing.
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20
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Cheng AMS, Chua L, Casas V, Tseng SCG. Morselized Amniotic Membrane Tissue for Refractory Corneal Epithelial Defects in Cicatricial Ocular Surface Diseases. Transl Vis Sci Technol 2016; 5:9. [PMID: 27226933 PMCID: PMC4874450 DOI: 10.1167/tvst.5.3.9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 04/15/2016] [Indexed: 01/15/2023] Open
Abstract
Purpose To evaluate the clinical efficacy of morselized amniotic membrane and umbilical cord tissue (MAU) in treating refractory corneal epithelial defect in ocular cicatricial diseases. Methods Retrospective review of four patients with ocular cicatricial diseases treated with topical MAU for corneal epithelial defects refractory to conventional treatments including topical lubricants, autologous serum, bandage contact lens, and tarsorraphy. Their symptoms, corneal staining, conjunctival inflammation, and visual acuity were compared before and after treatment. Results After topical application of MAU twice daily, two patients demonstrated rapid corneal epithelialization with prompt visual acuity improvement at the first day. All patients showed corneal epithelialization in 7.3 ± 2.6 days accompanied by a significant relief of symptoms, reduction of ocular surface inflammation, and improvement of visual acuity. Conclusion This pilot study suggests topical MAU can be developed into a novel treatment for treating refractory corneal epithelial defects. Translational Relevance Topical MAU can be an effective novel treatment for refractory corneal epithelial defects.
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Affiliation(s)
| | - Lorraine Chua
- Research and Development Department, TissueTech, Inc., Miami, FL, USA
| | | | - Scheffer C G Tseng
- Ocular Surface Center, Miami, FL, USA ; Research and Development Department, TissueTech, Inc., Miami, FL, USA
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21
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Tseng SCG. HC-HA/PTX3 Purified From Amniotic Membrane as Novel Regenerative Matrix: Insight Into Relationship Between Inflammation and Regeneration. Invest Ophthalmol Vis Sci 2016; 57:ORSFh1-8. [PMID: 27116665 PMCID: PMC4855828 DOI: 10.1167/iovs.15-17637] [Citation(s) in RCA: 87] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 08/03/2015] [Indexed: 12/22/2022] Open
Abstract
PURPOSE Human limbal palisade of Vogt is an ideal model for studying and practicing regenerative medicine due to their accessibility. Nonresolving inflammation is a common manifestation of limbal stem cell deficiency, which is the major cause of corneal blindness, and presents as a threat to the success of transplanted limbal epithelial stem cells. Clinical studies have shown that the efficacy of transplantation of limbal epithelial stem cells can be augmented by transplantation of cryopreserved human amniotic membrane (AM), which exerts anti-inflammatory, antiscarring, and antiangiogenic action to promote wound healing. METHODS Review of published data to determine the molecular action mechanism explaining how AM exerts the aforementioned therapeutic actions. RESULTS From the water-soluble extract of cryopreserved AM, we have biochemically purified one novel matrix component termed heavy chain (HC)-hyaluronan (HA)/pentraxin 3 (PTX3) as the key relevant tissue characteristic responsible for the aforementioned AM's efficacy. Heavy chain-HA is a complex formed by a covalent linkage between HA and HC1 of inter-α-trypsin inhibitor (IαI) by tumor necrosis factor-stimulated gene-6 (TSG-6). This complex may then be tightly associated with PTX3 to form HC-HA/PTX3 complex. Besides exerting an anti-inflammatory, antiscarring, and antiangiogenic effects, HC-HA/PTX3 complex also uniquely maintains limbal niche cells to support the quiescence of limbal epithelial stem cells. CONCLUSIONS We envision that HC-HA/PTX3 purified from AM can be used as a unique substrate to refine ex vivo expansion of limbal epithelial stem cells by maintaining stem cell quiescence, self-renewal and fate decision. Furthermore, it can also be deployed as a platform to launch new therapeutics in regenerative medicine by mitigating nonresolving inflammation and reinforcing the well-being of stem cell niche.
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Affiliation(s)
- Scheffer C. G. Tseng
- The R&D Department of TissueTech Inc., Ocular Surface Center, and Ocular Surface Research and Education Foundation, Miami, Florida, United States
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22
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Kohanim S, Palioura S, Saeed HN, Akpek EK, Amescua G, Basu S, Blomquist PH, Bouchard CS, Dart JK, Gai X, Gomes JAP, Gregory DG, Iyer G, Jacobs DS, Johnson AJ, Kinoshita S, Mantagos IS, Mehta JS, Perez VL, Pflugfelder SC, Sangwan VS, Sippel KC, Sotozono C, Srinivasan B, Tan DTH, Tandon R, Tseng SCG, Ueta M, Chodosh J. Acute and Chronic Ophthalmic Involvement in Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis - A Comprehensive Review and Guide to Therapy. II. Ophthalmic Disease. Ocul Surf 2016; 14:168-88. [PMID: 26882981 DOI: 10.1016/j.jtos.2016.02.001] [Citation(s) in RCA: 138] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Revised: 02/03/2016] [Accepted: 02/03/2016] [Indexed: 02/07/2023]
Abstract
Our purpose is to comprehensively review the state of the art with regard to Stevens- Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), with particular attention to improving the management of associated ocular surface complications. SJS and TEN are two ends of a spectrum of immune-mediated disease, characterized in the acute phase by a febrile illness followed by skin and mucous membrane necrosis and detachment. Part I of this review focused on the systemic aspects of SJS/TEN and was published in the January 2016 issue of this journal. The purpose of Part II is to summarize the ocular manifestations and their management through all phases of SJS/TEN, from acute to chronic. We hope this effort will assist ophthalmologists in their management of SJS/TEN, so that patients with this complex and debilitating disease receive the best possible care and experience the most optimal outcomes in their vision and quality of life.
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Affiliation(s)
- Sahar Kohanim
- Vanderbilt Eye Institute, Vanderbilt University School of Medicine, USA
| | - Sotiria Palioura
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, USA
| | - Hajirah N Saeed
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, USA
| | - Esen K Akpek
- The Wilmer Eye Institute, Johns Hopkins University School of Medicine, USA
| | - Guillermo Amescua
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, USA
| | | | | | | | - John K Dart
- Moorfields Eye Hospital, NHS Foundation Trust, UK
| | - Xiaowu Gai
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, USA
| | | | - Darren G Gregory
- Rocky Mountain Lions Eye Institute, University of Colorado School of Medicine, USA
| | - Geetha Iyer
- Dr G Sitalakshmi Memorial Clinic for Ocular Surface Disorders, Sankara Nethralaya, India
| | - Deborah S Jacobs
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, USA; Boston Foundation for Sight, USA
| | | | | | | | - Jodhbir S Mehta
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore
| | - Victor L Perez
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, USA
| | | | | | | | | | - Bhaskar Srinivasan
- Dr G Sitalakshmi Memorial Clinic for Ocular Surface Disorders, Sankara Nethralaya, India
| | - Donald T H Tan
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore
| | - Radhika Tandon
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, India
| | - Scheffer C G Tseng
- Ocular Surface Center, Ocular Surface Research & Education Foundation, USA
| | - Mayumi Ueta
- Kyoto Prefectural University of Medicine, Japan
| | - James Chodosh
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, USA.
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Jain R, Sharma N, Basu S, Iyer G, Ueta M, Sotozono C, Kannabiran C, Rathi VM, Gupta N, Kinoshita S, Gomes JAP, Chodosh J, Sangwan VS. Stevens-Johnson syndrome: The role of an ophthalmologist. Surv Ophthalmol 2016; 61:369-99. [PMID: 26829569 DOI: 10.1016/j.survophthal.2016.01.004] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2015] [Revised: 01/22/2016] [Accepted: 01/25/2016] [Indexed: 01/03/2023]
Abstract
Stevens-Johnson syndrome (SJS) is an acute blistering disease of the skin and mucous membranes. Acute SJS leads to the acute inflammation of the ocular surface and chronic conjunctivitis. If not properly treated, it causes chronic cicatricial conjunctivitis and cicatricial lid margin abnormalities. Persistent inflammation and ulceration of the ocular surface with cicatricial complications of the lids leads to chronic ocular sequelae, ocular surface damage, and corneal scarring. The destruction of the glands that secrete the tear film leads to a severe form of dry eye that makes the management of chronic SJS difficult. The option that is routinely used for corneal visual rehabilitation, keratoplasty, is best avoided in such cases. We describe the management strategies that are most effective during the acute and chronic stages of SJS. Although treatments for acute SJS involve immunosuppressive and immunomodulatory therapies, amniotic membrane transplantation is also useful. The options for visual rehabilitation in patients with chronic SJS are undergoing radical change. We describe the existing literature regarding the management of SJS and highlight recent advances in the management of this disorder.
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Affiliation(s)
- Rajat Jain
- Cornea, Ocular Surface and Anterior Segment Services, Department of Ophthalmology, drishtiCONE Eye Care, New Delhi, India
| | - Namrata Sharma
- Cornea and Refractive Surgery Services, Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Sayan Basu
- Cornea and Anterior Segment Services, Department of Ophthalmology, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Geetha Iyer
- C J Shah Cornea Services, Department of Ophthalmology, Dr. G Sitalakshmi Memorial Clinic for Ocular Surface Disorders, Sankara Nethralaya, Chennai, India
| | - Mayumi Ueta
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan; Department of Ophthalmology, Doshisha University, Kyotanabe, Japan
| | - Chie Sotozono
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Chitra Kannabiran
- Department of Ophthalmology, Kallam Anji Reddy Molecular Genetics Laboratory, L V Prasad Eye Institute (LVPEI), Hyderabad, Telangana, India
| | - Varsha M Rathi
- Cornea Services, Department of Ophthalmology, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Nidhi Gupta
- Department of Ophthalmology, Dr. Shroff Charity Eye Hospital, Delhi, India
| | - Shigeru Kinoshita
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - José A P Gomes
- Cornea and External Disease Service, Department of Ophthalmology, Federal University of Sao Paulo/Escola Paulista de Medicina (UNIFESP/EPM), São Paulo, Brazil; Advanced Ocular Surface Center (CASO), Department of Ophthalmology, Federal University of Sao Paulo/Escola Paulista de Medicina (UNIFESP/EPM), São Paulo, Brazil
| | - James Chodosh
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
| | - Virender S Sangwan
- Department of Ophthalmology, Srujana Center for Innovation, L V Prasad Eye Institute, Hyderabad, Telangana, India.
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Tseng SCG, He H, Zhang S, Chen SY. Niche Regulation of Limbal Epithelial Stem Cells: Relationship between Inflammation and Regeneration. Ocul Surf 2016; 14:100-12. [PMID: 26769483 DOI: 10.1016/j.jtos.2015.12.002] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 12/17/2015] [Accepted: 12/24/2015] [Indexed: 02/07/2023]
Abstract
Human limbal palisades of Vogt are the ideal site for studying and practicing regenerative medicine due to their accessibility. Nonresolving inflammation in limbal stroma is common manifestation of limbal stem cell (SC) deficiency and presents as a threat to the success of transplanted limbal epithelial SCs. This pathologic process can be overcome by transplantation of cryopreserved human amniotic membrane (AM), which exerts anti-inflammatory, antiscarring and anti-angiogenic action to promote wound healing. To determine how AM might exert anti-inflammation and promote regeneration, we have purified a novel matrix, HC-HA/PTX3, responsible for the efficacy of AM efficacy. HC-HA complex is covalently formed by hyaluronan (HA) and heavy chain 1 (HC1) of inter-α-trypsin inhibitor by the catalytic action of tumor necrosis factor-stimulated gene-6 (TSG-6) and are tightly associated with pentraxin 3 (PTX3) to form HC-HA/PTX3. In vitro reconstitution of the limbal niche can be established by reunion between limbal epithelial progenitors and limbal niche cells on different substrates. In 3-dimensional Matrigel, clonal expansion indicative of SC renewal is correlated with activation of canonical Wnt signaling and suppression of canonical bone morphogenetic protein (BMP) signaling. In contrast, SC quiescence can be achieved in HC-HA/PTX3 by activation of canonical BMP signaling and non-canonical planar cell polarity (PCP) Wnt signaling, but suppression of canonical Wnt signaling. HC-HA/PTX3 is a novel matrix mitigating nonresolving inflammation and restoring SC quiescence in the niche for various applications in regenerative medicine.
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Affiliation(s)
- Scheffer C G Tseng
- R&D Department, TissueTech, Inc., Ocular Surface Center, and Ocular Surface Research and Education Foundation, Miami, Florida, USA.
| | - Hua He
- R&D Department, TissueTech, Inc., Ocular Surface Center, and Ocular Surface Research and Education Foundation, Miami, Florida, USA
| | - Suzhen Zhang
- R&D Department, TissueTech, Inc., Ocular Surface Center, and Ocular Surface Research and Education Foundation, Miami, Florida, USA
| | - Szu-Yu Chen
- R&D Department, TissueTech, Inc., Ocular Surface Center, and Ocular Surface Research and Education Foundation, Miami, Florida, USA
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25
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Kang MH. Ocular Manifestations of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis. ACTA ACUST UNITED AC 2016. [DOI: 10.7599/hmr.2016.36.3.174] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Affiliation(s)
- Min Ho Kang
- Department of Ophthalmology, Hanyang University College of Medicine, Seoul, Korea
- Department of Ophthalmology, Hanyang University Guri Hospital, Guri, Korea
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26
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Cheng AMS, Zhao D, Chen R, Yin HY, Tighe S, Sheha H, Casas V, Tseng SCG. Accelerated Restoration of Ocular Surface Health in Dry Eye Disease by Self-Retained Cryopreserved Amniotic Membrane. Ocul Surf 2015; 14:56-63. [PMID: 26387870 DOI: 10.1016/j.jtos.2015.07.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Revised: 06/18/2015] [Accepted: 07/10/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE To evaluate the clinical efficacy of self-retained cryopreserved amniotic membrane in treating dry eye disease. METHODS Retrospective review of 10 patients treated with self-retained cryopreserved amniotic membrane (PROKERA® Slim [PKS], Bio-Tissue, Miami, FL) for moderate-to-severe dry eye refractory to conventional maximal medical treatments. Patients' symptoms, use of medications, conjunctival inflammation, corneal staining, and visual acuity were compared before and after treatment. RESULTS PKS was placed in 15 eyes of the 10 patients for 4.9 ± 1.5 days. All patients experienced symptomatic relief for a period of 4.2 ± 4.7 months (P<.001). Such improvement was accompanied by reduction of OSDI scores (P<.001), use of topical medications (P<.001), conjunctival hyperemia (P<.001), corneal staining (P<.001), and improvement of the visual acuity (P=.06). Linear regression analysis estimated that the optimal duration of PKS placement was 5 days to achieve an average symptom-free duration of 4 months in patients with dry eye. Surprisingly, PKS placement also generated improvement in the contralateral eyes. CONCLUSION This pilot study suggests that self-retained cryopreserved amniotic membrane via PKS can be used to treat moderate dry eye diseases and warrants further prospective controlled studies.
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Affiliation(s)
- Anny M S Cheng
- Ocular Surface Center and Tissuetech Inc., Miami FL, USA
| | - Dandan Zhao
- Department of Ophthalmology, Yan'An Hospital of Kunming City, Kunming, Yunnan, China
| | - Rendian Chen
- Department of Ophthalmology, Shenzhen Children's Hospital, Shenzhen, Guangzhou, China
| | - Han Y Yin
- Florida International University Herbert Wertheim College of Medicine, Miami, FL, USA
| | - Sean Tighe
- Ocular Surface Center and Tissuetech Inc., Miami FL, USA
| | - Hosam Sheha
- Ocular Surface Center and Tissuetech Inc., Miami FL, USA
| | - Victoria Casas
- Ocular Surface Center and Tissuetech Inc., Miami FL, USA
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Amnion doughnut: a novel method for sutureless fixation of amniotic membrane to the bulbar and palpebral conjunctiva in acute ocular-involving Stevens-Johnson syndrome. Cornea 2015; 33:1240-4. [PMID: 25222004 DOI: 10.1097/ico.0000000000000254] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The aim of this study was to describe a novel surgical method for the sutureless placement of amniotic membrane on the bulbar and palpebral conjunctiva in the setting of ocular-involving acute Stevens-Johnson syndrome. METHODS Within 6 days of an acute Stevens-Johnson episode, a 27-year-old male developed early symblepharon, despite aggressive lubrication and topical steroid therapy. He underwent symblepharon lysis and placement of an amniotic membrane wrapped around a symblepharon ring. RESULTS The patient maintained 20/20 vision in each eye with no recurrent symblepharon formation except for the temporal canthus (which was not covered with amniotic membrane). CONCLUSIONS Symblepharon rings covered in amniotic membrane provide a sutureless way to fixate amniotic membrane to the bulbar and palpebral conjunctiva. This gave very good anatomic and functional outcomes in a patient with acute Stevens-Johnson syndrome. Future research could be directed toward the development of a symblepharon ring that will be able to better protect the far temporal conjunctiva.
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Amniotic Membrane Transplantation in Acute Toxic Epidermal Necrolysis: Histopathologic Changes and Ocular Surface Features after 1-Year follow-up. Eur J Ophthalmol 2014; 24:667-75. [DOI: 10.5301/ejo.5000434] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2014] [Indexed: 11/20/2022]
Abstract
Purpose To evaluate ocular features and histopathologic changes in patients with toxic epidermal necrolysis (TEN) treated with amniotic membrane transplantation (AMT) in the acute phase. Methods A prospective study of 5 eyes (3 patients) with severe ocular involvement and 4 eyes (2 patients) with moderate involvement treated with AMT in the acute phase of TEN was performed. Patients underwent a complete ophthalmic assessment before the intervention and 3, 6, 9, and 12 months postoperatively. Tear film break-up time (BUT), Schirmer test, fluorescein_staining, corneal and conjunctival epithelial squamous metaplasia, ocular sequelae, and conjunctival retraction were measured. Results In patients with severe involvement, 2 eyes (40%) showed mild symblepharon and peripheral corneal neovascularization, and corneal epithelial defects, lid margin malposition, and trichiasis was found in 20% of the eyes; only 1 eye (20%) required surgery for structural defects. We did not find ocular sequelae after 1-year follow-up in the patients with moderate involvement. Only 1 eye (25%) developed mild symblepharon that did not require specific treatment. Amniotic membrane transplantation significantly improved the squamous metaplasia in corneal and conjunctival nonsecretory epithelial cells, and significantly improved the goblet cells density after 1-year follow-up. Conclusions Amniotic membrane transplantation performed for acute TEN reduced inflammation and ocular surface scarring, improved dry eye and squamous metaplasia. and decreased ocular sequelae in the chronic stage. Although further and prospective studies are needed, AMT may be the optimal treatment for acute TEN with severe or moderate ocular involvement.
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Heur M, Bach D, Theophanous C, Chiu GB. Prosthetic replacement of the ocular surface ecosystem scleral lens therapy for patients with ocular symptoms of chronic Stevens-Johnson syndrome. Am J Ophthalmol 2014; 158:49-54. [PMID: 24699156 DOI: 10.1016/j.ajo.2014.03.012] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Revised: 03/14/2014] [Accepted: 03/20/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE To evaluate the results of Prosthetic Replacement of the Ocular Surface Ecosystem (PROSE) scleral lens treatment on visual acuity and function in patients with ocular symptoms of chronic Stevens-Johnson syndrome (SJS). DESIGN Retrospective interventional case series. METHODS setting: Single multi-specialty institutional practice. study population: A chart review from July 2009 to July 2013 identified 19 patients with ocular symptoms from chronic SJS who were referred for PROSE fitting evaluation. Three patients deemed appropriate candidates were excluded because they were lost to follow-up during the fitting process. Only 1 eye was fitted in 4 patients because anatomic changes prohibited PROSE fitting in the fellow eye. Another patient chose to have PROSE fitting only in 1 eye. A total of 27 eyes of 16 patients who completed PROSE fitting were included in this study. intervention: PROSE scleral lens fitting. outcome measures: Visual acuity and visual function were assessed before and after PROSE fitting using Snellen acuity and Ocular Surface Disease Index (OSDI) survey. The OSDI survey is a validated questionnaire that assesses ocular surface disease in the context of vision-related function, ocular symptoms, and environmental triggers. RESULTS Visual acuity improved from 0.43 ± 0.35 logMAR pre-PROSE to 0.14 ± 0.22 logMAR post-PROSE (P = .0007) in SJS patients. OSDI scores improved from 70.4 ± 19.0 pre-PROSE to 37.4 ± 23.2 post-PROSE (P = .0002) in the same cohort. CONCLUSION The results of this study show that PROSE treatment is a viable option for improving visual acuity and function in SJS patients who failed conventional treatment.
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Current ophthalmologic treatment strategies for acute and chronic Stevens-Johnson syndrome and toxic epidermal necrolysis. Curr Opin Ophthalmol 2013; 24:321-8. [PMID: 23680755 DOI: 10.1097/icu.0b013e3283622718] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW To review the newer, effective ophthalmologic treatments for acute Stevens-Johnson syndrome (SJS) as well as the emerging treatment options for patients with chronic, severe ocular surface damage from the disease. RECENT FINDINGS Amniotic membrane transplantation (AMT) applied to the eyes and eyelids in the acute phase of SJS can prevent the devastating scarring and visual problems that characterize the chronic phase of the disease. The severity of ocular inflammation in the acute phase does not always correlate to the severity of skin and systemic involvement. Thus, it is crucial that all patients with SJS be evaluated by an ophthalmologist familiar with the current management of the disease, the potential urgency of the situation and the option of AMT. Although challenging, the severe, chronic ocular problems of SJS can be at least partially alleviated with autologous serum drops, mucous membrane grafting to replace scarred tarsal conjunctiva, specialized contact lenses (PROSE), conjunctival replacement surgery (COMET), limbal stem cell transplantation and kerotoprostheses. SUMMARY Early AMT is an effective treatment of acute SJS. Emerging treatments offer increased hope for those who have already suffered damage from SJS, but emphasis on the prevention of damage in the acute phase is most crucial.
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Yang J, Sim HC, Park DJ. Efficacy of the Sutureless Amniotic Membrane Patch for the Treatment of Ocular Surface Disorders. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2012. [DOI: 10.3341/jkos.2012.53.1.27] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Jenny Yang
- Department of Ophthalmology, Daegu Fatima Hospital, Daegu, Korea
| | - Hyun Chan Sim
- Department of Ophthalmology, Daegu Fatima Hospital, Daegu, Korea
| | - Dae Jin Park
- Department of Ophthalmology, Daegu Fatima Hospital, Daegu, Korea
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Fu Y, Gregory DG, Sippel KC, Bouchard CS, Tseng SC. The Ophthalmologist's Role in the Management of Acute Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis. Ocul Surf 2010; 8:193-203. [DOI: 10.1016/s1542-0124(12)70234-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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