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Yilmaz YC, Hayat SC, Bilgin GS, Altinkurt E. Tectonic and Therapeutic Urgent Penetrating Keratoplasty Outcomes. BEYOGLU EYE JOURNAL 2024; 9:61-68. [PMID: 38854901 PMCID: PMC11156477 DOI: 10.14744/bej.2024.69772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 04/07/2024] [Accepted: 05/08/2024] [Indexed: 06/11/2024]
Abstract
Objectives It was aimed to to provide a comprehensive assessment of therapeutic and tectonic emergency keratoplasty procedures, along with a discussion on their indications, prognostic factors for functional success, and postoperative outcomes. Methods Patients who underwent therapeutic or tectonic Penetrating Keratoplasty (PKP) procedures between 2010 to 2021 in our hospital were retrospectively reviewed. Patient files were evaluated in terms of demographic characteristics, medical and ocular history, visual acuity, initial ocular findings, presence of glaucoma, causative microorganisms, details of surgical procedures, complications, graft transparency and globe integrity. Visual acuity was measured as light perception, hand motion, counting finger, Snellen chart and subsequently converted to Logarithm of the Minimum Angle of Resolution (logMAR) for statistical analysis. Results The study included a total of 43 patients, with 16 (37.2%) being female. The average age of the participants was 59.72±18.1 years. The corrected distance visual acuity improved from 2.3±0.66 logMAR preoperatively to 1.72±1.02 logMAR postoperatively (p=0.001). After PKP, anatomical success was achieved in all eyes and functional success was achieved in 23 (51.1%) eyes. It was observed that only preoperative glaucoma had a significant impact on graft survival rate (p=0.002, Figure 2), as well as functional success (p=0.022). Conclusion Urgent keratoplasty is a viable treatment option for cases involving an actively uncontrolled infection or corneal disease with perforation. In cases of graft rejection, bacteria, fungi, and viral pathogens were detected as causative agents, whereas only bacteria were detected as the causative agents in cases of pre and post-operative endophthalmitis. Early diagnosis and treatment play crucial roles in achieving anatomical and functional success.
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Affiliation(s)
- Yusuf Cem Yilmaz
- Department of Ophthalmology, University of Health Sciences, Cam and Sakura City Hospital, Istanbul, Türkiye
| | - Serife Ciloglu Hayat
- Department of Ophthalmology, University of Health Sciences, Cam and Sakura City Hospital, Istanbul, Türkiye
| | - Gizem Sayar Bilgin
- Department of Ophthalmology, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Türkiye
| | - Emre Altinkurt
- Department of Ophthalmology, Istanbul University Faculty of Medicine, Istanbul, Türkiye
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Peng R, Chi M, Xiao G, Qu H, Shen Z, Zhao Y, Hong J. The outcomes of corneal sight rehabilitating surgery in Stevens-Johnson syndrome: case series. BMC Ophthalmol 2024; 24:205. [PMID: 38711013 DOI: 10.1186/s12886-024-03461-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 04/21/2024] [Indexed: 05/08/2024] Open
Abstract
PURPOSE To summarize the outcomes of corneal sight rehabilitating surgery in Stevens-Johnson syndrome (SJS). METHODS This is a retrospective analysis of a consecutive case series. Twenty-four eyes of 18 SJS patients were included in this study. The ocular parameters, surgical procedures, postoperative complications, and additional treatments of the cases were reviewed. RESULTS A total of 29 corneal sight rehabilitating surgeries, which consists of 9 keratoplasties, 8 Keratolimbal allograft (KLAL) and 12 combined surgeries (keratoplasty and KLAL simultaneously) were performed on the 24 eyes. All patients were treated with glucocorticoid eyedrops and tacrolimus eyedrops for anti-rejection treatment without combining systemic immunosuppression, except two patients who were prescribed prednisone tablets for the management of systemic conditions. The mean follow-up period was 50.6 ± 28.1 months. The optimal visual acuity (VA) (0.74 ± 0.60 logarithm of the minimum angle of resolution [logMAR]) and endpoint VA (1.06 ± 0.82 logMAR) were both significantly better than the preoperative VA (1.96 ± 0.43 logMAR) (95% CI, p = 0.000). 57.1% patients (8/14) were no longer in the low vision spectrum, and 88.9% patients (8/9) were no longer blind. The mean epithelialization time was 7.1 ± 7.6 weeks. The success rate was 86.7%. Additional treatments for improving epithelialization included administration of serum eyedrops (n = 10), contact lens (n = 15), amniotic membrane transplantation (n = 6), and tarsorrhaphy (n = 8). Complications included delayed epithelialization (n = 4, over 12 weeks), glaucoma (n = 11), and severe allograft opacity (n = 4). Only one graft rejection was observed. CONCLUSIONS Keratoplasty and KLAL can remarkably enhance VA and improve low vision or even eliminate blindness for ocular complications of SJS. The outcome of the surgeries was correlated with the preoperative ocular situation and choice of operative methods.
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Affiliation(s)
- Rongmei Peng
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
- Key Laboratory of Vision Loss and Restoration, Ministry of Education, Beijing, China
| | - Miaomiao Chi
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
- Key Laboratory of Vision Loss and Restoration, Ministry of Education, Beijing, China
| | - Gege Xiao
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
- Key Laboratory of Vision Loss and Restoration, Ministry of Education, Beijing, China
| | - Hongqiang Qu
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
- Key Laboratory of Vision Loss and Restoration, Ministry of Education, Beijing, China
| | - Zhan Shen
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
- Key Laboratory of Vision Loss and Restoration, Ministry of Education, Beijing, China
| | - Yinghan Zhao
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
- Key Laboratory of Vision Loss and Restoration, Ministry of Education, Beijing, China
| | - Jing Hong
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China.
- Key Laboratory of Vision Loss and Restoration, Ministry of Education, Beijing, China.
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Thorel D, Ingen-Housz-Oro S, Benaïm D, Daien V, Gabison E, Saunier V, Béral L, Touboul D, Brémond-Gignac D, Robert M, Vasseur R, Royer G, Dereure O, Milpied B, Bernier C, Welfringer-Morin A, Bodemer C, Cordel N, Tauber M, Burillon C, Servant M, Couret C, Vabres B, Tétart F, Cassagne M, Kuoch MA, Muraine M, Delcampe A, Gueudry J. Ocular sequelae of epidermal necrolysis: French national audit of practices, literature review and proposed management. Orphanet J Rare Dis 2023; 18:51. [PMID: 36906580 PMCID: PMC10007779 DOI: 10.1186/s13023-023-02616-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Accepted: 01/15/2023] [Indexed: 03/13/2023] Open
Abstract
Stevens-Johnson Syndrome (SJS) and toxic epidermal necrolysis (TEN) are serious and rare diseases, most often drug-induced, and their incidence has been estimated at 6 cases/million/year in France. SJS and TEN belong to the same spectrum of disease known as epidermal necrolysis (EN). They are characterized by more or less extensive epidermal detachment, associated with mucous membrane involvement, and may be complicated during the acute phase by fatal multiorgan failure. SJS and TEN can lead to severe ophthalmologic sequelae. There are no recommendations for ocular management during the chronic 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. Ophthalmologists and dermatologists from the French reference center for epidermal necrolysis were asked to complete a questionnaire on management practices in the chronic phase of SJS/TEN. The survey focused on the presence of a referent ophthalmologist at the center, the use of local treatments (artificial tears, corticosteroid eye drops, antibiotic-corticosteroids, antiseptics, vitamin A ointment (VA), cyclosporine, tacrolimus), the management of trichiatic eyelashes, meibomian dysfunction, symblepharons, and corneal neovascularization, as well as the contactologic solutions implemented. Eleven ophthalmologists and 9 dermatologists from 9 of the 11 centers responded to the questionnaire. Based on questionnaire results, 10/11 ophthalmologists systematically prescribed preservative-free artificial tears, and 11/11 administered VA. Antiseptic or antibiotic eye drops or antibiotic-corticosteroid eye drops were recommended as needed by 8/11 and 7/11 ophthalmologists, respectively. In case of chronic inflammation, topical cyclosporine was consistently proposed by 11/11 ophthalmologists. The removal of trichiatic eyelashes was mainly performed by 10/11 ophthalmologists. Patients were referred to a reference center for fitting of scleral lenses (10/10,100%). Based on this practice audit and literature review, we propose an evaluation form to facilitate ophthalmic data collection in the chronic phase of EN and we also propose an algorithm for the ophthalmologic management of ocular sequelae.
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Affiliation(s)
- Dhyna Thorel
- Ophthalmology Department, CHU Charles Nicolle Rouen, Rouen, France.
- Reference Center for Toxic Bullous Dermatoses and Severe Drug Reactions TOXIBUL, Créteil, France.
| | - Saskia Ingen-Housz-Oro
- Reference Center for Toxic Bullous Dermatoses and Severe Drug Reactions TOXIBUL, Créteil, France
- Dermatology Department, AP-HP, Henri Mondor Hospital, Univ Paris Est Créteil EpidermE, Créteil, France
| | - Daniel Benaïm
- Reference Center for Toxic Bullous Dermatoses and Severe Drug Reactions TOXIBUL, Créteil, France
- Ophthalmology Department, AP-HP, Henri Mondor Hospital, Créteil, France
| | - Vincent Daien
- Reference Center for Toxic Bullous Dermatoses and Severe Drug Reactions TOXIBUL, Créteil, France
- Ophthalmology Department CHU Montpellier, Montpellier, France
| | - Eric Gabison
- 6Ophthalmology Department, Hôpital Fondation Adolphe de Rothschild, Paris, France
| | - Valentine Saunier
- Reference Center for Toxic Bullous Dermatoses and Severe Drug Reactions TOXIBUL, Créteil, France
- Ophthalmology Department, CHU Bordeaux, Bordeaux, France
| | - Laurence Béral
- Reference Center for Toxic Bullous Dermatoses and Severe Drug Reactions TOXIBUL, Créteil, France
- Ophthalmology Department, CHU Pointe À Pitre, Pointe À Pitre, Guadeloupe, France
| | - David Touboul
- Reference Center for Toxic Bullous Dermatoses and Severe Drug Reactions TOXIBUL, Créteil, France
- Ophthalmology Department, CHU Bordeaux, Bordeaux, France
| | - Dominique Brémond-Gignac
- Reference Center for Toxic Bullous Dermatoses and Severe Drug Reactions TOXIBUL, Créteil, France
- Ophthalmology Department, Hôpital Universitaire Necker Enfants-Malades, APHP, Paris, France
| | - Matthieu Robert
- Reference Center for Toxic Bullous Dermatoses and Severe Drug Reactions TOXIBUL, Créteil, France
- Ophthalmology Department, Hôpital Universitaire Necker Enfants-Malades, APHP, Paris, France
| | - Robin Vasseur
- Reference Center for Toxic Bullous Dermatoses and Severe Drug Reactions TOXIBUL, Créteil, France
- Ophthalmology Department, CHU de Nantes, Nantes, France
| | - Gérard Royer
- Reference Center for Toxic Bullous Dermatoses and Severe Drug Reactions TOXIBUL, Créteil, France
- Ophthalmology Department, AP-HP, Henri Mondor Hospital, Créteil, France
| | - Olivier Dereure
- Reference Center for Toxic Bullous Dermatoses and Severe Drug Reactions TOXIBUL, Créteil, France
- Dermatology Department, CHU Montpellier, Montpellier, France
| | - Brigitte Milpied
- Reference Center for Toxic Bullous Dermatoses and Severe Drug Reactions TOXIBUL, Créteil, France
- Dermatology Department, CHU Bordeaux, Bordeaux, France
| | - Claire Bernier
- Reference Center for Toxic Bullous Dermatoses and Severe Drug Reactions TOXIBUL, Créteil, France
- Dermatology Department, CHU Nantes, Nantes, France
| | - Anne Welfringer-Morin
- Reference Center for Toxic Bullous Dermatoses and Severe Drug Reactions TOXIBUL, Créteil, France
- Dermatology Department, AP-HP, Hôpital Universitaire Necker Enfants-Malades, APHP, Paris, France
| | - Christine Bodemer
- Reference Center for Toxic Bullous Dermatoses and Severe Drug Reactions TOXIBUL, Créteil, France
- Dermatology Department, AP-HP, Hôpital Universitaire Necker Enfants-Malades, APHP, Paris, France
| | - Nadège Cordel
- Reference Center for Toxic Bullous Dermatoses and Severe Drug Reactions TOXIBUL, Créteil, France
- Dermatology and Clinical Immunology Department, CHU Guadeloupe, Pointe À Pitre, , Guadeloupe, France
| | - Marie Tauber
- Reference Center for Toxic Bullous Dermatoses and Severe Drug Reactions TOXIBUL, Créteil, France
- Dermatology Department, CHU de Toulouse, Toulouse, France
| | - Carole Burillon
- Reference Center for Toxic Bullous Dermatoses and Severe Drug Reactions TOXIBUL, Créteil, France
- Ophthalmolgy Department, CHU Lyon, Lyon, France
| | - Marion Servant
- Reference Center for Toxic Bullous Dermatoses and Severe Drug Reactions TOXIBUL, Créteil, France
- Ophthalmology Department, CHU de Nantes, Nantes, France
| | - Chloe Couret
- Reference Center for Toxic Bullous Dermatoses and Severe Drug Reactions TOXIBUL, Créteil, France
- Ophthalmology Department, CHU de Nantes, Nantes, France
| | - Bertrand Vabres
- Reference Center for Toxic Bullous Dermatoses and Severe Drug Reactions TOXIBUL, Créteil, France
- Ophthalmology Department, CHU de Nantes, Nantes, France
| | - Florence Tétart
- Ophthalmology Department, CHU Charles Nicolle Rouen, Rouen, France
- Dermatology Department, CHU Charles Nicolle Rouen, Rouen, France
| | - Myriam Cassagne
- Reference Center for Toxic Bullous Dermatoses and Severe Drug Reactions TOXIBUL, Créteil, France
- Ophthalmology Department, CHU de Toulouse, Toulouse, France
| | - Marie-Ange Kuoch
- Reference Center for Toxic Bullous Dermatoses and Severe Drug Reactions TOXIBUL, Créteil, France
- Ophthalmology Department, AP-HP, Henri Mondor Hospital, Créteil, France
| | - Marc Muraine
- Ophthalmology Department, CHU Charles Nicolle Rouen, Rouen, France
- Reference Center for Toxic Bullous Dermatoses and Severe Drug Reactions TOXIBUL, Créteil, France
| | - Agnès Delcampe
- Ophthalmology Department, CHU Charles Nicolle Rouen, Rouen, France
- Reference Center for Toxic Bullous Dermatoses and Severe Drug Reactions TOXIBUL, Créteil, France
| | - Julie Gueudry
- Ophthalmology Department, CHU Charles Nicolle Rouen, Rouen, France
- Reference Center for Toxic Bullous Dermatoses and Severe Drug Reactions TOXIBUL, Créteil, France
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Wakamatsu TH, Dos Santos MS, Barreiro TP, Sant'Anna AEBPP, Murta F, da Costa AX, Marculino LGC, de Alcântara RJA, de Farias CC, Gomes JÁP. Clinical Aspects of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis With Severe Ocular Complications in Brazil. Front Med (Lausanne) 2021; 8:649369. [PMID: 34222274 PMCID: PMC8252916 DOI: 10.3389/fmed.2021.649369] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 04/19/2021] [Indexed: 12/01/2022] Open
Abstract
Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are acute and potentially fatal inflammatory vesiculobullous reactions that affect the skin and mucous membranes, and which are most often triggered by particular medications and infections. In Brazil, the drugs most frequently associated with TEN and SJS include cold medicine such as dipyrone and NSAIDs, followed by carbamazepine, phenobarbital, penicillin, and allopurinol. Genetic variations have been found to increase the risk of SJS/TEN in response to triggering factors such as medications. The most closely associated genes found in Brazilian cold-medicine-related SJS/TEN patients with severe ocular complications are HLA-A*66:01 in those of mixed African and European ancestry and HLA-B*44:03 and HLA-C*12:03 in those of solely European ancestry. Our classification system for grading ocular surface complication severity in SJS/TEN patients revealed the most severe complications to be limbal stem cell deficiency and dry eye. Changes to the conjunctival flora have also been observed in SJS/TEN patients. Our group identified bacterial colonization in 95% of the eyes (55.5% of which were gram-positive cocci, 25.5% of which were gram-negative bacilli, and 19% of which were gram-positive bacilli). Several new treatment options in the acute and chronic ocular management of the SJS/TEN patients have been described. This article highlights some Brazilian institutions' contributions to ocular surface care in both the acute phase (including the use of amniotic membrane transplantation) and the chronic phase (such as eyelid margin and fornix reconstruction, minor salivary gland transplantation, amniotic membrane and limbal transplantation, scleral contact lenses, anti-angiogenic eyedrops for corneal neovascularization, ex-vivo cultivated limbal epithelium transplantation, conjunctival-limbal autografting, oral mucosa transplantation, and keratoprosthesis).
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Affiliation(s)
| | | | | | | | - Fabíola Murta
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil.,Moorfields Eye Hospital, London, United Kingdom
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Amniotic Membrane as a Main Component in Treatments Supporting Healing and Patch Grafts in Corneal Melting and Perforations. J Ophthalmol 2020; 2020:4238919. [PMID: 32148944 PMCID: PMC7042504 DOI: 10.1155/2020/4238919] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 01/12/2020] [Accepted: 01/27/2020] [Indexed: 11/22/2022] Open
Abstract
Purpose To report on surgical approaches using amniotic membrane applications and patch grafts in corneal melting and perforations. Anatomical and functional results, including advantages and disadvantages of the interventions, will also be explored. Methods A five-year retrospective analysis of 189 surgical treatments involving corneal melting with perforation was performed. In one evaluated treatment type, a graft of amniotic membrane, often folded one to three times, was sutured with the epithelial side facing the previously mechanically debrided corneal tissue. A larger monolayer amniotic patch was then sutured, with the epithelial side facing the top of the first membrane, to the perilimbal conjunctiva. For corneal patch grafts, the size-fitting technique of graft trephination was applied, and the donor-recipient junctions were sewn with interrupted sutures. All the procedures were evaluated, noting outcomes and complications of surgery, preoperative and postoperative visual acuities, postoperative intraocular pressures, graft rejection, and other late comorbidities and complications. Results We performed 119 amniotic membrane applications (63%) and 70 corneal patch grafts (37%). Anatomical reconstruction of the anterior chamber was achieved in 157 eyes, of which 102 eyes (86%) received an amniotic membrane and 55 eyes (79%) were treated with the patch graft technique. In 63 eyes (33%), more than one amnion or graft treatment was necessary to close the corneal perforation. Conclusions The success of medical and surgical management depends on the cause of corneal melting, and amniotic membrane applications often require further intervention; nevertheless, patch grafts deliver better tectonic reconstruction than amniotic membrane alone.
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