title: Amniotic membrane in the surgical management of acute toxic epidermal necrolysis.
abstract: OBJECTIVE
  To report a new surgical technique to manage severe acute toxic epidermal necrolysis.
  
  
  METHODS
  Two interventional case reports.
  
  
  METHODS
  Two patients. Case 1: A 6-year-old boy had severe toxic epidermal necrolysis develop after being treated with trimethoprim and sulfamethoxazole for chronic otitis media. Both eyes and eyelids were affected. He underwent bilateral lysis of symblepharon and all adhesions and bilateral amniotic membrane transplantation to the entire ocular surface except the cornea. Loss of eyelid skin required transplantation of amniotic membrane to all four eyelids and strips of amniotic membrane at the eyelid margins. Case 2: An 8-year-old girl with severe toxic epidermal necrolysis associated with mycoplasma pneumonia had bilateral, diffuse keratoconjunctivitis, diffuse corneal epithelial defects, and bilateral symblepharon. Amniotic membrane transplantation was performed bilaterally, using a symblepharon ring in the left eye.
  
  
  METHODS
  Amniotic membrane transplantation.
  
  
  METHODS
  Preservation of normal ocular and eyelid surfaces and prevention of blindness.
  
  
  RESULTS
  Case 1: Thirty-six months after bilateral ocular surgery, there is no symblepharon, good ocular surface wetting, and an uncorrected bilateral vision of 20/20. Case 2: Amniotic membrane transplantation protected both ocular surfaces and prevented conjunctival contracture without adhesion of the eyelids to the ocular surface. The central vision was preserved. There was minimal peripheral corneal vascularization and mild conjunctival scarring of the tarsal conjunctival surface 34 months postoperatively.
  
  
  CONCLUSIONS
  These are the first cases of acute toxic epidermal necrolysis treated with amniotic membrane transplantation and the first use of the procedure on external eyelid surfaces with good healing of the eyelids. This new treatment for acute toxic epidermal necrolysis preserves normal ocular and eyelid surfaces and may prevent blindness.
authors.affiliation: Department of Ophthalmology, Loyola University at Chicago, Maywood, Illinois 60153, USA.
authors.forename: Thomas
authors.initials: T
authors.lastname: John
authors.forename: Gary N
authors.initials: GN
authors.lastname: Foulks
authors.forename: Michelle E
authors.initials: ME
authors.lastname: John
authors.forename: Kenneth
authors.initials: K
authors.lastname: Cheng
authors.forename: Dean
authors.initials: D
authors.lastname: Hu
mesh_terms: D000208:Acute Disease; D000650:Amnion / Q000637:transplantation*; D002648:Child; D005141:Eyelid Diseases / Q000209:etiology / Q000601:surgery*; D005260:Female; D006801:Humans; D007637:Keratoconjunctivitis / Q000209:etiology / Q000601:surgery*; D008297:Male; D013508:Ophthalmologic Surgical Procedures; D011019:Pneumonia, Mycoplasma / Q000150:complications; D013262:Stevens-Johnson Syndrome / Q000209:etiology / Q000601:surgery*; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000009:adverse effects; D014792:Visual Acuity
chemical_list: D015662:Trimethoprim, Sulfamethoxazole Drug Combination