Amniotic membrane transplantation in acute phase of toxic epidermal necrolysis with severe corneal involvement.
OBJECTIVE
To report successful management of acute stage toxic epidermal necrolysis (TEN) by amniotic membrane transplantation.


METHODS
Interventional case report. METHOD/INTERVENTION: A 6-year-old boy who had convulsions and fever due to encephalitis was treated by oral phenobarbital. Two weeks later, he developed a high fever and skin rashes involving >40% of the body, with a positive Nikolsky sign and oral blisters. Examination under general anesthesia performed 5 days after the onset of eye symptoms showed severe inflammation and ulceration on the lid margin and the tarsal conjunctiva in both eyes, a total corneal epithelial defect in the right eye, and a geographical corneal epithelial defect in the left eye. Amniotic membrane was transplanted in both eyes as a patch to cover the entire ocular surface, including upper and lower lid margins.


RESULTS
Fourteen days after amniotic membrane transplantation, complete corneal and conjunctival epithelialization was observed in the left eye. However, a second amniotic membrane transplantation was performed in the right eye, which still had a total corneal and conjunctival epithelial defect, and resulted in complete epithelialization 14 days later. Corrected visual acuity improved to 20/16 without any superficial punctate keratitis in both eyes 6 months postoperatively. Minimal symblepharon and peripheral scarring were observed only in the right eye.


CONCLUSIONS
Amniotic membrane transplantation performed at the acute phase of TEN is highly effective not only in reducing inflammation and preventing scarring in the conjunctival surface, but also in restoring corneal epithelial integrity in eyes with both corneal and conjunctival ulceration. As a result, in this case it prevented sight-threatening cicatricial complications at the chronic stage.
Kobayashi
Akira
A
Department of Ophthalmology, Kanazawa University Graduate School of Medical Science, Kanazawa, Ishikawa, Japan. kobaya@kenroku.kanazawa-u.ac.jp
Yoshita
Tsuyoshi
T
Sugiyama
Kazuhisa
K
Miyashita
Kengo
K
Niida
Yo
Y
Koizumi
Shoichi
S
Tseng
Scheffer C G
SC
D000208:Acute Disease; D000650:Amnion / Q000637:transplantation*; D002452:Cell Count; D002648:Child; D003229:Conjunctival Diseases / Q000601:surgery*; D003316:Corneal Diseases / Q000601:surgery*; D015925:Cryopreservation; D019573:Epithelium, Corneal / Q000166:cytology / Q000502:physiology; D005141:Eyelid Diseases / Q000601:surgery*; D006801:Humans; D008297:Male; D010634:Phenobarbital / Q000009:adverse effects; D013262:Stevens-Johnson Syndrome / Q000209:etiology / Q000601:surgery*; D014021:Tissue Preservation; D014945:Wound Healing / Q000502:physiology
D010634:Phenobarbital