Ocular surface reconstruction of Steven Johnson syndrome / toxic epidermal necrolysis affected eye - A case report. Issue 1 (January 2023)

• Record Type: Journal Article
• Authors: Tsai, Tzu-Yun; Chang, Hou-Tai; Weng, Shao-Wei; Chu, Chan-Ching; Wang, Yi-Chun; Zhao, Zhanqi; Mai, Elsa Lin-Chin
• Is Part Of: Heliyon. Volume 9:Issue 1(2023)
• Publication Date: 2023-01
• Subjects: Stevens-Johnson syndrome -- Toxic epidermal necrolysis -- Limbal stem cell deficiency -- Hyperbaric oxygen therapy -- Case report -- Minor salivary gland transplant -- Limbal stem cell transplantation -- Oral buccal mucosa flap transplantation; AMT amniotic membrane transplantation -- CLAL conjunctival limbal allograft -- HBOT Hyperbaric oxygen therapy -- LSCD Limbal stem cell deficiency -- CLAU conjunctival limbal autograft -- lr-CLAL living-related conjunctival limbal allograft -- HLA typing human leucocyte antigen typing -- SJS Steven Johnson syndrome -- SOC severe ocular complication -- TEN toxic epidermal necrolysis -- CLET Cultivated limbal epithelial transplantation; Research -- Periodicals; Medical sciences -- Periodicals; Natural history -- Periodicals; Social sciences -- Periodicals; Earth sciences -- Periodicals; Physical sciences -- Periodicals; 507.2
• DOI: 10.1016/j.heliyon.2022.e12590
• Languages: English
• ISSNs: 2405-8440

Abstract

Abstract: Introduction: Toxic epidermal necrolysis (TEN), also known as Steven Johnson syndrome (SJS), is a devastating disease. Patients develop blindness and symblepharon despite multiple reconstructive surgeries. We report a case of SJS/TEN with ocular involvement where treatment with hyperbaric oxygen therapy (HBOT) resulted in a significant improvement in the visual acuity after surgery. Case presentation: A woman with SJS/TEN with severe ocular complication (SOC) had limbal stem cell deficiency and symblepharon of the superior and inferior fornix. Pannus grew over her cornea, reducing the vision to counting finger. The symblepharon produced shortening of the fornix, causing entropion. The in-turned eyelid caused her eyelashes to rub against the cornea, causing great damage to the ocular surface. Limbal stem cell deficiency led to the loss of normal corneal morphology and invasion of the pannus onto the central visual axis, resulting in poor vision. She experienced ocular inflammation for 3 months before transfer to our hospital for admission. Ophthalmic examination showed bilateral corneal opacity with conjunctivalization, and inferior and superior fornix shortening. Symblepharon-lysis with amniotic membrane transplantation was attempted but the outcome was poor, with recurrence of superior scaring and symblepharon. She finally underwent major reconstructive surgery with allogeneic limbal stem cell transplantation with her sister as the donor, autologous minor salivary gland transplantation, and oral buccal mucosa flap transplant. HBOT was given daily post-surgery for supporting the grafts and suppressing inflammation. After 17 HBOT sessions and 3 months of autoserum drops, her left eye vision increased from the initial counting finger to 0.4 due to the successful growth of the corneal epithelium from the donor corneal limbal cell line. When a scleral contact lens which vaulted over the corneal limbal area was fitted, her vision improved to 0.8 due to redressal of high order aberration and astigmatism from the cornea scar. Conclusion: After major reconstruction of the ocular surface with multiple cell type transplants, including limbal stem cells, minor salivary gland acinar cells, and oral mucosa cells, HBOT proved useful in supporting the graft uptake and oxygenation of the donor tissues, enabling fast recovery of the grafts and cell functioning, with eventual return of the working vision of the patient. Abstract : Stevens-Johnson syndrome, Toxic epidermal necrolysis, Limbal stem cell deficiency, Hyperbaric oxygen therapy, Case report.