Amniotic membrane treatment in the acute phase of Stevens-Johnson syndrome/toxic epidermal necrolysis may be effective in warding off severe vision loss, a team of researchers from Boston report. However, eyelid-related complications and dry eye are still a common issue in these patients, they add.

The investigators reviewed electronic records of all patients with a diagnosis of Stevens-Johnson syndrome/toxic epidermal necrolysis at Massachusetts Eye and Ear between 2008 and 2018. They identified 55 eyes of 29 patients who received amniotic membrane treatment and were followed for three or more months.

All 55 eyes received the first amniotic membrane treatment at about five days after onset of skin rash. Of these, 56% of eyes underwent amniotic membrane transplant while 44% received a self-retained amniotic membrane.

Of note: 40% of eyes required repeat treatments with either method. Patient follow up was approximately 2.5 years, and at the last visit, best-corrected visual acuity was 20/40 or better in 87% of eyes.

 The researchers found the most common complications in the chronic phase were meibomian gland disease in 78% of eyes and dry eye in 58%.

The investigators stressed every patient with Stevens-Johnson syndrome/toxic epidermal necrolysis should have an ophthalmology consult immediately after diagnosis, and a low threshold for treatment with amniotic membrane for acute ocular involvement should be considered. Sight-threatening complications may still develop after treatment and long-term follow-up is necessary, they added.

"Prospective studies in SJS are difficult given it is a rare disease with potentially severe outcomes. Large retrospective studies such as this give us insight into how to manage these patients," says researcher Hajirah Saeed, MD, of Massachusetts Eye & Ear. "It seems clear that acute early treatment of the ocular surface with amniotic membrane, while not a panacea, can significantly reduce chronic ocular complications in SJS."

Shanbhag SS, Hall L, Chodosh J, Saeed HN. Long-term outcomes of amniotic membrane treatment in acute Stevens-Johnson syndrome/toxic epidermal necrolysis. Ocul Surf. March 18, 2020. [Epub ahead of print].