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Amniotic membrane transplantation in acute phase of toxic epidermal necrolysis with severe corneal involvement.

Kobayashi A, Yoshita T, Sugiyama K, Miyashita K, Niida Y, Koizumi S, Tseng SC

Department of Ophthalmology, Kanazawa University Graduate School of Medical Science, Kanazawa, Ishikawa, Japan. kobaya@kenroku.kanazawa-u.ac.jp

OBJECTIVE: To report successful management of acute stage toxic epidermal necrolysis (TEN) by amniotic membrane transplantation. DESIGN: Interventional case report. METHOD/INTERVENTION: A 6-year-old boy who had convulsions and fever due to encephalitis was treated by oral phenobarbital. Two weeks later, he developed a high fever and skin rashes involving >40% of the body, with a positive Nikolsky sign and oral blisters. Examination under general anesthesia performed 5 days after the onset of eye symptoms showed severe inflammation and ulceration on the lid margin and the tarsal conjunctiva in both eyes, a total corneal epithelial defect in the right eye, and a geographical corneal epithelial defect in the left eye. Amniotic membrane was transplanted in both eyes as a patch to cover the entire ocular surface, including upper and lower lid margins. RESULTS: Fourteen days after amniotic membrane transplantation, complete corneal and conjunctival epithelialization was observed in the left eye. However, a second amniotic membrane transplantation was performed in the right eye, which still had a total corneal and conjunctival epithelial defect, and resulted in complete epithelialization 14 days later. Corrected visual acuity improved to 20/16 without any superficial punctate keratitis in both eyes 6 months postoperatively. Minimal symblepharon and peripheral scarring were observed only in the right eye. CONCLUSIONS: Amniotic membrane transplantation performed at the acute phase of TEN is highly effective not only in reducing inflammation and preventing scarring in the conjunctival surface, but also in restoring corneal epithelial integrity in eyes with both corneal and conjunctival ulceration. As a result, in this case it prevented sight-threatening cicatricial complications at the chronic stage.

Published 3 January 2006 in Ophthalmology, 113(1): 126-32.
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