title: Plasmapheresis, Intravenous Immunoglobulins, and Autologous Serum Eyedrops in the Acute Eye Complications of Toxic Epidermal Necrolysis.
abstract: OBJECTIVE
  Toxic epidermal necrolysis (TEN) is a rare, life-threatening, drug-induced, mucocutaneous disease, which can severely affect the ocular surface. The purpose of this study was to investigate the efficacy of plasmapheresis, human IV immunoglobulins (IVIg), and autologous serum (AS) eyedrops in the treatment of the severe acute ocular complications of TEN.
  
  
  METHODS
  A retrospective chart review of all patients admitted to the Burn Unit, Azienda Ospedaliero-Universitaria-Sassari, Sassari, Italy, from 2009 to 2015, identified 9 patients (2 men, 7 women; mean age 63.8 ± 24.7 years) with TEN. Bilateral, acute ocular surface complications were observed in 7 (78%) patients; 3 showed catarrhal conjunctivitis, whereas 4 had severe pseudomembranous conjunctivitis and corneal ulcers.
  
  
  RESULTS
  All patients with TEN were immediately treated with plasmapheresis and human IVIg, which produced a marked improvement in the patients' general condition. In the 3 with catarrhal conjunctivitis, preservative-free artificial tears and topical antibiotics were beneficial. In the 4 with severe pseudomembranous conjunctivitis and corneal ulcers, treatment with AS eyedrops resulted in corneal and conjunctival epithelium healing over 3-6 weeks. After a minimum follow-up of at least 12 months, there were minimal/mild residual signs and symptoms of dry eye.
  
  
  CONCLUSIONS
  Plasmapheresis and IVIg may be life-saving and contribute to reduce ocular surface inflammation in TEN. Autologous serum eyedrops, prepared after plasmapheresis completion and IVIg infusion, may be helpful in the management of the severe acute ocular complications of TEN.
authors.affiliation: 1 Section of Ophthalmology, Department of Surgical, Microsurgical, and Medical Sciences, University of Sassari, Sassari - Italy.|2 Unità Operativa di Oculistica, Azienda Ospedaliero-Universitaria-Sassari, Sassari - Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Pinna
authors.affiliation: 1 Section of Ophthalmology, Department of Surgical, Microsurgical, and Medical Sciences, University of Sassari, Sassari - Italy.
authors.forename: Eleonora
authors.initials: E
authors.lastname: Nuvoli
authors.affiliation: 1 Section of Ophthalmology, Department of Surgical, Microsurgical, and Medical Sciences, University of Sassari, Sassari - Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Blasetti
authors.affiliation: 3 Centro Ustioni, Azienda Ospedaliero-Universitaria-Sassari, Sassari - Italy.
authors.forename: Maria Alma
authors.initials: MA
authors.lastname: Posadinu
authors.affiliation: 1 Section of Ophthalmology, Department of Surgical, Microsurgical, and Medical Sciences, University of Sassari, Sassari - Italy.|2 Unità Operativa di Oculistica, Azienda Ospedaliero-Universitaria-Sassari, Sassari - Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Boscia
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003231:Conjunctivitis / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D003316:Corneal Diseases / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D005141:Eyelid Diseases / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D005260:Female; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009883:Ophthalmic Solutions; D010956:Plasmapheresis / Q000379:methods*; D012189:Retrospective Studies; D044967:Serum; D013262:Stevens-Johnson Syndrome / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*
chemical_list: D016756:Immunoglobulins, Intravenous; D009883:Ophthalmic Solutions
keywords: Acute ocular surface complications; Autologous serum eyedrops; Plasmapheresis; Toxic epidermal necrolysis