Challenges in the management of bilateral eyelid closure in Stevens-Johnson Syndrome

Aziza, Yulia; Harada, Kiyomi; Ueta, Mayumi; Fukuoka, Hideki; Kinoshita, Shigeru; Sotozono, Chie

doi:10.1016/j.ajoc.2022.101473

Cited by 4 publications

(4 citation statements)

References 47 publications

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“… 32 The findings in our recent case-series study revealed that limbal-rigid CL-wear therapy post COMET resulted in a gradual improvement of BCVA. 33 …”

Section: Discussionmentioning

confidence: 99%

Strategic combination of cultivated oral mucosal epithelial transplantation and postoperative limbal-rigid contact lens-wear for end-stage ocular surface disease: a retrospective cohort study

Aziza,

Imai,

Itoi

et al. 2023

Br J Ophthalmol

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PurposeTo provide the long-term outcome of patients with end-stage severe ocular surface disease (OSD) consecutively treated with cultivated oral mucosal epithelial transplantation (COMET) followed by limbal-rigid contact lens (CL)-wear therapy.DesignRetrospective cohort.MethodsIn 23 eyes of 18 patients with severe OSD who underwent COMET surgery between 2002 and 2019 and who were followed with limbal-rigid CL-wear therapy for at least 1 year postoperative, patient demographics, best-corrected visual acuity (BCVA, logMAR), Ocular Surface Grading Scores (OSGS), surgical indication and adverse events were reviewed. Primary and secondary outcomes were BCVA and OSGS changes at baseline and final examination, respectively.ResultsThis study involved 16 patients with Stevens-Johnson syndrome and 2 patients with mucous membrane pemphigoid (mean age: 59±15 years). The indications for COMET were as follows: corneal reconstruction for vision improvement (10 eyes (43.5%)), corneal reconstruction for persistent epithelial defect (4 eyes (17.4%)) and conjunctival (fornix) reconstruction for symblepharon release (9 eyes (39.1%)). The mean duration of CL-wear postsurgery was 6.4±3.9 years (range: 1.4 to 13.3 years). The mean BCVA at baseline and at final follow-up was logMAR 1.9±0.5 and 1.3±0.7, respectively (p<0.05). Compared with those at baseline, the OSGSs for symblepharon and upper and lower fornix shortening showed significant improvement at each follow-up time point post treatment initiation. No serious intraoperative or postoperative adverse events were observed.ConclusionIn patients afflicted with severe OSD, COMET combined with limbal-rigid CL-wear therapy postsurgery was found effective for vision improvement and ocular surface stabilisation.

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“… 32 The findings in our recent case-series study revealed that limbal-rigid CL-wear therapy post COMET resulted in a gradual improvement of BCVA. 33 …”

Section: Discussionmentioning

confidence: 99%

Strategic combination of cultivated oral mucosal epithelial transplantation and postoperative limbal-rigid contact lens-wear for end-stage ocular surface disease: a retrospective cohort study

Aziza,

Imai,

Itoi

et al. 2023

Br J Ophthalmol

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“…One case series of 5 eyes with eyelid closure after Stevens-Johnson syndrome used AMT or MMG to preserve eyelid opening and visual acuity. 48 In a case series of patients with severe symblepharon after chemical and thermal burns, cultivated limbal epithelial cells with amniotic membrane as the carrier led to good ocular surface and fornix reconstruction in the majority of cases. 51 Studies of patients with late-stage ocular cicatricial pemphigoid show significantly improved fornix depth after AMT, although depending on the underlying disease process, symblepharon may recur.…”

Section: Other Cicatricial Disordersmentioning

confidence: 99%

Section: Eyelid and Fornixmentioning

confidence: 99%

A Review of Current Uses of Amniotic Membrane Transplantation in Ophthalmic Plastic and Reconstructive Surgery

Parikh,

Conger,

et al. 2023

Ophthalmic Plastic &Amp; Reconstructive Surgery

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Purpose: To review and summarize the existing literature on the clinical applications of amniotic membrane transplantation (AMT) in ophthalmic plastic and reconstructive surgery. Methods: A literature review was conducted on the PubMed database using the following search terms: “amniotic membrane” and “eyelid” or “orbit” or “fornix” or “socket” or “lacrimal”. Results: In total 516 articles resulted from the search, of which 62 were included. Numerous cases and case series have been published on the use of amniotic membrane transplantation for ocular surface reconstruction, eyelid and forniceal reconstruction, and cicatricial eyelid abnormalities. Surgical methods of securing the graft vary. Few comparative studies exist; some show a similar or improved result when compared to oral mucous membrane grafting for certain indications. Conclusions: Amniotic membrane transplantation can be a useful tool for the oculoplastic surgeon when faced with a case requiring reconstruction of the posterior lamellae, particularly in patients without other graft donor sites available, and uses of AMT continue to expand. Additional studies directly comparing AMT to other reconstructive techniques would be helpful in choosing between the available surgical techniques and standardizing best practices.

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“…It is a severe mucocutaneous disorder that can severely affect the skin, the oral, the ocular, the genital, the gastrointestinal, and the anal. 1,4,5 Drugs are among the most common etiology of SJS, besides a bacterial infection, vaccination, or graft-versushost disease. 6,7 Medications that most commonly cause SJS are certain antibiotics, acetaminophen, anticonvulsant drugs, allopurinol, sulfonamide drugs, nonsteroidal anti-inflammatory drugs (NSAIDs), and other drugs.…”

Section: Introductionmentioning

confidence: 99%

Acute and severe ocular manifestations of a patient with Stevens-Johnson Syndrome in RSUD Wangaya: a case report

Oeiyano¹,

Hadisusanto²,

Tanaya³

et al. 2022

Intisari Sains Medis

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Background: Stevens-Johnson syndrome is a severe mucocutaneous disorder with high mortality rates and potentially life-threatening. Ocular manifestations in SJS occurred up to 81%, with manifestation ranging from conjunctiva hyperemia, cicatrizing conjunctivitis with symblepharon, corneal ulceration, corneal blisters and perforation, which can potentially lead to permanent vision loss. Case Description: A 34-year-old male patient was being consulted to ophthalmologist department with the diagnosis Stevens-Johnson syndrome, he was complaint bilateral upper and lower eyelid palpebral conjunctiva adhesion to bulbar conjunctiva. The ophthalmological examination cannot be examined due to the adhesion then the patient was performed bilateral symblepharon separation of the eyelid using blunt-tip of surgical scissors under local anesthesia. After the procedure, the visual acuity was around 3/60 for both eyes. The anterior segment examination in both eyes showed that the palpebral was edema, peeling of the skin. The conjunctiva appears to be chemosis, conjunctival injection, with mucopurulent secret in both eyes. The patient was treated with antibiotic combined with steroid eye ointment and eye drop. Conclusion: Ocular manifestations of SJS are mostly mild-moderate. However, several cases possess grave complication and may progress to vision loss. Treatment for the ocular sequelae can reduce the risk of long-term visual morbidity. Knowing the etiology along with the progression of the disease is necessary for early diagnosis and prompt treatment.

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Challenges in the management of bilateral eyelid closure in Stevens-Johnson Syndrome

Cited by 4 publications

References 47 publications

Strategic combination of cultivated oral mucosal epithelial transplantation and postoperative limbal-rigid contact lens-wear for end-stage ocular surface disease: a retrospective cohort study

Strategic combination of cultivated oral mucosal epithelial transplantation and postoperative limbal-rigid contact lens-wear for end-stage ocular surface disease: a retrospective cohort study

A Review of Current Uses of Amniotic Membrane Transplantation in Ophthalmic Plastic and Reconstructive Surgery

Acute and severe ocular manifestations of a patient with Stevens-Johnson Syndrome in RSUD Wangaya: a case report

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