In Ocular Stevens-Johnson, Amniotic Membrane Improves Vision, Eases Complications

For ocular Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) cases, the established treatment, amniotic membrane transplant (AMT) greatly mitigates long-term complications and improves visual outcome, according to a report published in the American Journal of Ophthalmology. With this study, researchers demonstrated the effectiveness of both dehydrated AMT (deAMT) and cryopreserved AMT (cryoAMT), which resulted in similar long-term complication scores, representing an evolution of this treatment for patients with ocular SJS/TEN.

Researchers reviewed charts of individuals treated at a large burn center in North Carolina from April 2014 to January 2022. The cohort comprised 85 eyes of 43 patients with severe ocular Stevens-Johnson syndrome and toxic epidermal necrolysis, all of whom received deAMT over eyelid margins to palpebral conjunctivae, and fit into the fornix — but for corneal and bulbar conjunctival regions; 85% of eyes underwent deAMT (2014 to 2020) and 15% cryoAMT (starting in 2020).

Of all, 72% of patients with ocular SJS/TEN reached a final BCVA of at least 20/40. Patients who underwent deAMT achieved a mean BCVA of 20/34, and those with cryoAMT 20/30, statistically similar.

Repeat AMT was needed in 32 eyes of 18 individuals with ocular SJS/TEN, 38% for each transplant type. The cause of initial disease reaction was determined to be antibiotics in 32%, anticonvulsants 30%, antipsychotics 22%, and smaller percentages for NSAIDS, pathogens, or other.

“This study includes the largest cohort of patients to date (85 eyes) receiving AMT for ocular SJS/TEN. Here, we demonstrate comparable efficacy between both methods in preserving visual acuity,” the researchers explain. “The use of cryopreserved AMT rings
demonstrated a similar long-term complication rate compared to dehydrated AMTs,
however symblepharon formation was seen more frequently with use of cryopreserved
AMT rings.”

DeAMT attained a 1.4 complication score, compared with 1.6 for cryoAMT (P =.5), although more eyes with ocular SJS/TEN that received a cryoAMT developed symblepharon (P <.05). “The higher rate of symblepharon formation may be attributable to the different types of symblepharon rings used between the groups, with the cryopreserved AMT rings used in the cryoAMT group and custom IV tubing used in the dehydrated AMT group,” according to the researchers, also noting a longer average interval from ocular sign onset to cryoAMT.

Initial resolution in participants with White heritage occurred an average of 9.8 days from admission, compared with 20.1 days in patients of Black race (P =.005). Prior studies have discovered correlations between the HLA-B*1502 allele in individuals with Asian ancestry and ocular Stevens-Johnson syndrome triggered by carbamazepine, as well as a relationship between HLA-B*1501 frequency with higher ocular SJS/TEN prevalence in those of Asian and Black race.

CryoAMT was only placed over the corneal surface, so comparison of inter-group non-corneal results may not reflect its level of contribution. The smaller cryo-AMT group also limited the data, in addition to physicians’ slightly different topical regimens and records for pre-AMT grading.