Procedure May Restore Stevens-Johnson Affected Eyes

Corneal neovascularization and cicatrization (scarring) around the eyelids caused by Stevens-Johnson syndrome (erythema multiforme). The eye shown is almost completely blind as a result of Stevens-Johnson syndrome.
Researchers show how COMET procedure can restore ocular surface anatomy and revive visual performance.

The ocular surface anatomy and function of eyes with chronic Stevens-Johnson syndrome (SJS) sequelae may be successfully restored and improved with cultivated oral mucosal epithelial transplantation (COMET), according to study results published in the American Journal of Ophthalmology.

Researchers report that COMET produces favorable and sustained visual results when performed in eyes with severe ocular surface disease and corneal scarring. Study researchers’ objective was to observe the outcomes of COMET when performed in eyes with chronic SJS sequelae.

In this study, 41 patients with chronic SJS sequelae presented to a cornea clinic in India. COMET was aimed to restore the ocular surface anatomy in 45 eyes by reconstructing conjunctival fornices and improving the visual axis. Researchers evaluated preoperative and postoperative change in corrected distance visual acuity (CDVA), severity scores of various ocular surface parameters, and complications.

Researchers revealed a significant improvement in mean CDVA from a preoperative value of 2.5±0.5 to 1.54±0.74 logarithm of the minimum angle of resolution [logMAR] at 12 months, and 1.49±0.98 logMAR at the 24-month follow-up. Overall, 82.2% of eyes experienced an improvement in visual acuity, 13.3% experienced no change, and 4.4%  experienced worsened visual acuity. Approximately 55% of eyes showed postoperative improvement in CDVA to at least 6/60. The mean total ocular surface severity score improved from a preoperative value of 29.1±9.7 to a postoperative value of 18.7±7.2 at the 2-year follow-up visit. Visual acuity worsened in 2 eyes that developed persistent epithelial defects, progressing to corneal melting in 1 eye and microbial keratitis in the second eye to require tectonic and therapeutic grafts.

The study researchers concluded that patients with SJS and eyes with chronic sequelae may be ideal candidates for COMET, as this treatment may provide successful long-term stability of visual acuity and functional improvement.


Venugopal R, Nagpal R, Mohanty S, et al. Outcomes of cultivated oral mucosal epithelial transplantation in eyes with chronic Stevens-Johnson Syndrome sequelaeAm J Ophthalmol. Published online August 17, 2020. doi: 10.1016/j.ajo.2020.08.022