Amniotic membrane with living related corneal limbal/conjunctival allograft for ocular surface reconstruction in Stevens-Johnson syndrome.
OBJECTIVE
To report the use of preserved amniotic membrane and living related corneal limbal/conjunctival transplantation in total limbal stem cell and conjunctival deficiency secondary to severe Stevens-Johnson syndrome.


METHODS
Prospective, noncomparative, interventional case series.


METHODS
Ten eyes of 10 patients with total limbal stem cell and conjunctival deficiency secondary to Stevens-Johnson syndrome underwent excision of cicatricial tissue followed by amniotic membrane and living related corneal limbal/conjunctival transplantation.


METHODS
Reconstruction of corneal epithelium (clear appearance without epithelial defect, normal fluorescein permeability, and the absence of conjunctiva-derived goblet cells on impression cytologic testing), decrease in corneal vascularization, and improvement in visual acuity.


RESULTS
During a mean follow-up of 16.7 months, satisfactory ocular surface reconstruction was obtained in 2 eyes (20%), with reduced inflammation and vascularization and a mean epithelialization time of 3 weeks. Surgical failure was observed in 4 cases (40%) and complications (infection) in 4 cases (40%). Visual acuity improved in 4 eyes (40%), remained stable in 5 eyes (50%), and decreased in 1 eye (10%).


CONCLUSIONS
Amniotic membrane and living related corneal limbal/conjunctival transplantation were successful in 20% of severe cases of total limbal stem cell and conjunctival deficiency secondary to Stevens-Johnson syndrome. A high proportion of postoperative complications, in particular, infection, seemed to jeopardize a favorable outcome.
Gomes
José A P
JA
Department of Ophthalmology, Paulista School of Medicine/Federal University of São Paulo, São Paulo, Brazil. japgomes@uol.com.br
Santos
Myrna S
MS
Ventura
Angela S
AS
Donato
Waleska B C
WB
Cunha
Marcelo C
MC
Höfling-Lima
Ana Luísa
AL
D000293:Adolescent; D000328:Adult; D000650:Amnion / Q000637:transplantation*; D002648:Child; D003228:Conjunctiva / Q000166:cytology*; D003231:Conjunctivitis / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D004847:Epithelial Cells / Q000637:transplantation*; D005260:Female; D006801:Humans; D016850:Limbus Corneae / Q000166:cytology*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D013508:Ophthalmologic Surgical Procedures; D011183:Postoperative Complications; D011446:Prospective Studies; D033581:Stem Cell Transplantation; D013262:Stevens-Johnson Syndrome / Q000150:complications / Q000473:pathology / Q000601:surgery*; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D014792:Visual Acuity