Academic Unit of Ophthalmology, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham and Midland Eye Centre, Birmingham, United Kingdom.
Cornea. 2013 Mar;32(3):365-9. doi: 10.1097/ICO.0b013e318243fee3.
Toxic epidermal necrolysis (TEN) is a devastating form of Stevens-Johnson syndrome (SJS) with acute and chronic ocular complications. We present a novel aggressive combination strategy, termed "Triple-TEN", for the management of acute ocular TEN designed to minimize the risk of chronic, blinding sequelae.
Two patients with life-threatening TEN accompanied by severe ocular surface defects and fulminant symblephara formation underwent "Triple-TEN" management of their acute ocular disease under aseptic techniques in the critical care setting, after failed treatment with intensive topical therapy and surgical division of symblephara. The Triple-TEN protocol comprises (1) subconjunctival triamcinolone (Kenalog 20 mg) administered into each of the fornices to curb the local inflammatory response without compromising systemic immunity, (2) placement of amniotic membrane tissue mounted on a polycarbonate skirt (ProKera) over the corneal and limbal regions to facilitate reepithelialization of the ocular surface, and (3) insertion of a steeply curved acrylic scleral shell spacer (Technovent, SC21) to vault the lids away from the globe providing a barrier to symblephara formation.
In both cases, ocular surface inflammation resolved within 4 weeks with no progression of conjunctival cicatrization or evidence of limbal epithelial stem cell failure at 1 year follow-up. There were no long-term complications of the Triple-TEN regimen.
Aggressive treatment with the Triple-TEN protocol for acute ocular TEN resistant to first-line therapy, may help prevent long-term blinding sequelae.
中毒性表皮坏死松解症（TEN）是史蒂文斯-约翰逊综合征（SJS）的一种严重形式，伴有急性和慢性眼部并发症。我们提出了一种新的强化联合治疗策略，称为“Triple-TEN”，用于治疗急性眼部 TEN，旨在最大程度地降低慢性、致盲后遗症的风险。
两名患有危及生命的 TEN 患者，伴有严重的眼表缺陷和暴发性睑球粘连，在重症监护环境下，在强化局部治疗和睑球粘连切开术失败后，采用无菌技术接受“Triple-TEN”急性眼部疾病管理。Triple-TEN 方案包括：（1）在穹窿部注射曲安奈德（Kenalog 20 mg）抑制局部炎症反应，同时不损害全身免疫力；（2）在角膜和缘区域放置载有羊膜组织的聚碳酸酯裙（ProKera），促进眼表上皮化；（3）插入陡峭弯曲的丙烯酸巩膜壳间隔物（Technovent，SC21），使眼睑远离眼球，形成防止睑球粘连的屏障。
在这两种情况下，眼表炎症在 4 周内得到缓解，没有结膜瘢痕化进展或 1 年随访时发现缘上皮干细胞衰竭的证据。Triple-TEN 方案无长期并发症。
对于一线治疗抵抗的急性眼部 TEN，采用 Triple-TEN 方案强化治疗可能有助于预防长期致盲后遗症。
