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Amniotic membrane transplantation for Stevens–Johnson syndrome/toxic epidermal necrolysis: the Toronto experience
  1. Yelin Yang1,
  2. Simon Sheung Man Fung2,
  3. Hall Chew1,3,
  4. Kamiar Mireskandari1,4,
  5. Asim Ali1,4
  1. 1 Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
  2. 2 Department of Ophthalmology, University of California Los Angeles, Los Angeles, California, USA
  3. 3 Department of Ophthalmology and Vision Sciences, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
  4. 4 Department of Ophthalmology and Vision Sciences, Hospital for Sick Children, Toronto, Ontario, Canada
  1. Correspondence to Asim Ali, Hospital for Sick Children, 555 University Ave, Toronto, Ontario M5G 1X8, Canada;asim.ali{at}

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Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) form a spectrum of vesiculobullous disorders affecting skin and mucous membranes. Although rare, they are associated with a high mortality rate of up to 35% in adults and up to 17% in children.1 2 Ocular involvement is common and is present acutely in 43–81% of hospitalised patients.3 4 This ranges from conjunctival injection and membrane formation to epithelial sloughing of eyelid, conjunctiva and cornea. Chronic ocular complications occur in 20–79% of patients.1 Fusion between bulbar conjunctiva and fornices leads to symblepharon, while tarsal conjunctival scarring is associated with lid keratinisation and cicatricial lid changes including entropion, trichiasis and distichiasis.5 All of these changes contribute to corneal complications including limbal stem cell deficiency (LSCD) and eventual ocular surface failure with poor visual prognosis.6

Prompt treatment during the acute inflammatory stage of SJS/TEN is important in preventing chronic sequelae.1 Use of amniotic membrane transplantation (AMT) to suppress inflammation and promote healing during the acute phase was first reported by John et al in 2002.7 Amniotic membrane contains anti-inflammatory cytokines and suppresses innate immunity, thus having anti-inflammatory as well as anti-scarring effects.8 Its effectiveness has also been demonstrated in other ocular surface disorders such as chemical burns, persistent epithelial defect and ocular cicatricial pemphigoid.9–12 Since then, AMT has been shown to reduce inflammation and promote healing in the acute stage of SJS/TEN in several case series.8 13–15 In a large retrospective study, Hsu et al have showed the benefit of early AMT in patients with moderate and severe ocular involvement from SJS/TEN compared with medical management alone.16 Recently, Shanbhag et al reported that patients who received AMT in the acute period had significantly reduced vision-threatening complications; however, complications still occurred in this group mostly …

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  • Twitter Simon Sheung Man Fung @DrSimonFung.

  • Contributors Amniotic membrane transplantation was performed by one of the three surgeons (AA, KM, HC). All authors contributed to manuscript equally.

  • Funding AA and KM are both consultants for Santen.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.

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