Amniotic membrane transplantation for ocular surface reconstruction in Stevens-Johnson syndrome

Purpose: To evaluate amniotic membrane transplantation (AMT) for ocular sur face reconstruction in Stevens-Johnson syndrome (SJS), Designs Prospective interventional case series. Participants: Ten consecutive patients (10 eyes) with SJS that underwent AM T as the first step in staged ocular surface reconstruction were included. Methods: Amniotic membrane was processed under sterile conditions from a fr esh placenta obtained from cesarean section in a seronegative pregnant woma n and stored at -70 degrees C, Symblepharon release, excision of epibulbar fibrous tissue, and clearing of the fibrovascular membrane over the cornea was performed in all cases. Amniotic membrane covered the entire bulbar sur face up to the fornices in five eyes; cornea and the perilimbal area in two eyes; cornea, the inferior bulbar surface, and the lower fornix in two eye s; and cornea and the superior bulbar surface in one eye. Obliterated forni ces were deepened by use of fornix-formation sutures in all eyes. Symblepha ron ring was placed postoperatively for 3 weeks to 2 months. Mean postopera tive follow-up was 13.5 months (SD, +/-3.8 months; range, 9-30 months). Main Outcome Measures: Restoration of adequate bulbar surface free of symbl epharon and good fornix depth were the main outcome measures. Results: Complete corneal reepithelization occurred in all eyes between 1 a nd 6 weeks. Adequate bulbar surface and fornix depth were achieved in nine eyes, all of which were free of symblepharon at the final follow-up visit. Cicatricial entropion resolved in four of five lower eyelids and one of two upper eyelids after AMT, One patient had a central corneal melt that requi red or necessitated a penetrating keratoplasty. Conclusions: AMT restores adequate bulbar surface and fornix depth and prev ents recurrence of symblepharon in severe cases of SJS, (C) 2000 by the Ame rican Academy of Ophthalmology.