Original ArticlesSurgical treatment of children blinded by Stevens-Johnson syndrome☆
Section snippets
Patients and methods
We have treated four children, all boys aged 8 to 10 years (Table 1), since we started performing ocular surface reconstruction for Stevens-Johnson syndrome in 1994. We used slit-lamp biomicroscopy and impression cytology7 to evaluate the ocular surface and check for healthy conjunctival epithelium. Impression cytology measures the presence of goblet cells or skin-like cells on the bulbar conjunctiva by pressing a small strip of filter paper (Millipore, Bedford, Massachusetts) after topical
Results
Among four children on whom we performed ocular surface reconstruction, two cases were unsuccessful, whereas the other two cases were completely successful, providing almost normal visual acuity. The preoperative conditions were different in the successful and unsuccessful cases, resulting in different outcomes. In the two unsuccessful cases the patients had a completely keratinized epithelium without conjunctival epithelium and no reflex tearing. The two successful cases had a healthy
Discussion
Although Stevens-Johnson syndrome is a rare disease, it can occur at any age, often causing blindness in both children and adults. Cicatricial keratoconjunctivitis has been considered difficult to treat, with poor surgical results.10, 11 Although the new approach of using epithelium stem cell transplantation has begun, the results are not yet promising.5, 11 In our latest report, ocular surface reconstruction failed in children.5 However, because such impaired vision can have a substantial
Acknowledgements
We acknowledge the referrals from and discussions with Drs Woo Chan Park (Case 3), Akitoshi Yoshida and Sho Igarashi (Case 1), Mitsuru Nakazawa and Yuko Wada (Case 4), and Takahiko Motohashi (Case 2). We also acknowledge Drs Scheffer Tseng and Edward Holland for their consultation on one of our patients.
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Cited by (47)
Acute and Chronic Ophthalmic Involvement in Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis - A Comprehensive Review and Guide to Therapy. II. Ophthalmic Disease Part i (Systemic Disease) was published in the January 2016 issue of this journal.
2016, Ocular SurfaceCitation Excerpt :Therefore, SJS/TEN patients are not candidates for limbal autografts.170 Keratolimbal allografts, although initially reported to have promise,63,65,66,171-175 have a high rate of failure after one year due to graft rejection and loss of donor epithelium, infections, glaucoma, and other complications, leading to a final visual outcome that may be worse than prior to surgery.56,173,176 The use of living-related limbal allografts was not successful in one study with two SJS/TEN patients with severe ocular surface disease,177 and in another study showed a marginally improved ocular surface in two of ten eyes in patients with SJS/TEN.56
Ophthalmic use of blood-derived products
2015, Survey of OphthalmologyCitation Excerpt :This result is important as finding an entirely autologous method for bioengineering epithelial cell equivalents eliminates risks associated with using bovine material, including transmission of infection and graft rejection. AS has also been used after ocular surface reconstruction in adults and children with severe ocular surface disease325,326 and in an experimental rabbit model to assist conjunctivalization over a polyethylene orbital implant post evisceration.157 Salman et al reported a higher rate of epithelial wound healing using undiluted serum compared with physiologic saline in induced corneal alkali wounds in rabbits.
Limbal stem cell disease: Treatment and advances in technology
2011, Saudi Journal of OphthalmologyCitation Excerpt :Conditions such as aniridia and iatrogenic LSC deficiency with mild to moderate conjunctival involvement (Schwartz and Holland, 1998) are ideal for KLAL. However, KLAL alone should not be used in recipients with inadequate tear film (Shimazaki et al., 2000), significant active inflammation, and/or severe conjunctival involvement with keratinization of the ocular surface secondary to loss of both LSC and conjunctival epithelial stem cells (Tsubota and Shimazaki, 1999). As mentioned previously, systemic immunosuppression is required with any allograft.
Early clinical use of amniotic membrane in medicine and ophthalmology
2006, Ocular SurfaceThe amniotic membrane in ophthalmology
2004, Survey of Ophthalmology
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This study was supported by the Medical School Faculty and Alumni Grants of Keio University Medical School, Tokyo, Japan.