From the University of North Carolina Hospitals, Department of Ophthalmology, Chapel Hill, North Carolina, USA.
From the University of North Carolina Hospitals, Department of Ophthalmology, Chapel Hill, North Carolina, USA.
Am J Ophthalmol. 2023 Dec;256:80-89. doi: 10.1016/j.ajo.2023.07.026. Epub 2023 Aug 19.
To analyze the clinical outcome of amniotic membrane transplantation in patients with ocular Stevens-Johnson syndrome/toxic epidermal necrolysis at a major burn unit.
Retrospective, non-randomized interventional study.
A retrospective chart review from April 2014 to January 2022 of 43 patients (85 eyes) at a burn center who underwent amniotic membrane transplantation (AMT) for severe ocular Stevens-Johnson Syndrome (SJS), toxic epidermal necrolysis (TEN), or SJS/TEN was performed. Data regarding the clinical course and outcome were obtained. A comparison between the use of cryopreserved AMT rings (cryoAMT) and dehydrated AMT (deAMT) was also assessed.
A total of 85 eyes in 43 patients underwent AMT for severe ocular SJS/TEN. Of the eyes, 72 received deAMT with symblepharon ring, whereas 13 received cryoAMT over the cornea surface. All patients had deAMT placed over the eyelid margins and palpebral conjunctivae and tucked into the fornices. The average best-corrected visual acuity (BCVA) on last follow-up examination was 20/33, 20/30, and 20/34 in all eyes, the cryoAMT group, and the deAMT group, respectively (no significant difference between groups). The most common suspected inciting agent was lamotrigine (17% of all cases). The average long-term complication score was 1.4, with no significant difference between the cryoAMT group (1.6) and the deAMT group (1.4, P = .5). Symblepharon formation was seen more in the cryoAMT group compared to the deAMT group (P < .05).
The use of AMTs in severe ocular SJS/TEN greatly mitigates long-term complications and improves visual outcome. The retrospective nature of this study limits substantial conclusions regarding any significant difference in outcome between AMT treatment methods. Nevertheless, the use of cryopreserved AMT rings has a similar outcome profile compared to use of dehydrated AMTs with symblepharon ring. Further research is needed to evaluate optimal AMT techniques.
分析在一家主要烧伤中心接受羊膜移植的眼 Stevens-Johnson 综合征/中毒性表皮坏死松解症患者的临床结果。
回顾性、非随机干预研究。
对 2014 年 4 月至 2022 年 1 月在烧伤中心接受羊膜移植（AMT）治疗严重眼 Stevens-Johnson 综合征（SJS）、中毒性表皮坏死松解症（TEN）或 SJS/TEN 的 43 例患者（85 只眼）进行回顾性图表审查。获得有关临床过程和结果的数据。还评估了冷冻保存的 AMT 环（cryoAMT）和脱水 AMT（deAMT）的使用比较。
共有 43 例患者的 85 只眼因严重眼 SJS/TEN 而行 AMT。在这些眼睛中，72 只接受了带 symblepharon 环的 deAMT，而 13 只接受了角膜表面的 cryoAMT。所有患者的眼睑边缘和睑结膜均放置 deAMT，并塞入穹窿。末次随访时平均最佳矫正视力（BCVA）分别为所有眼、cryoAMT 组和 deAMT 组的 20/33、20/30 和 20/34（组间无显著差异）。最常见的可疑诱发剂是拉莫三嗪（占所有病例的 17%）。平均长期并发症评分为 1.4，cryoAMT 组（1.6）和 deAMT 组（1.4，P =.5）之间无显著差异。与 deAMT 组相比，cryoAMT 组更易发生 symblepharon 形成（P <.05）。
在严重眼 SJS/TEN 中使用 AMT 可大大减轻长期并发症并改善视力预后。本研究的回顾性限制了对 AMT 治疗方法之间任何结果差异的实质性结论。尽管如此，与使用带 symblepharon 环的脱水 AMT 相比，冷冻保存的 AMT 环的使用具有相似的结果特征。需要进一步研究来评估最佳的 AMT 技术。
