INTRODUCTION

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 …