Minor salivary glands and labial mucous membrane graft in the treatment of severe symblepharon and dry eye in patients with Stevens-Johnson syndrome (original) (raw)
Related papers
Mucous membrane grafting for the post-Steven-Johnson syndrome symblepharon: A case report
Indian Journal of Ophthalmology, 2011
An 18-year-old woman was referred with late sequelae of chloroquine-induced Steven-Johnson syndrome. At the time of presentation, the symblepharon was involving the upper lids to almost the whole of the cornea, and part of the lower bulbar conjunctiva with the lower lid bilaterally. Other ocular examinations were not possible due to the symblepharon. B-scan ultrasonography revealed acoustically clear vitreous, normal chorioretinal thickness, and normal optic nerve head, with an attached retina. Conjunctivo-corneal adhesion released by superficial lamellar dissection of the cornea. Ocular surface reconstruction was carried out with a buccal mucous membrane. A bandage contact lens was placed over the cornea followed by the symblepharon ring to prevent further adhesion. The mucosal graft was well taken up along with corneal re-epithelization. Best corrected visual acuity of 20/120 in both sides after 1 month and 20/80 after 3 months was achieved and maintained till the 2.5year follow-up.
Ophthalmic Plastic & Reconstructive Surgery, 2010
PURPOSE. To evaluate the effectiveness of autologous labial salivary gland with labial mucous membrane graft in a rhesus monkey model with severe dry eye. METHODS. Eight eyes of eight rhesus monkeys with severe dry eye were included. Four eyes underwent autologous labial salivary gland and mucous membrane graft (group 1) and four eyes served as controls (group 2). The ocular surface was evaluated before and after transplantation surgery (at 1, 4, 8, 12, and 24 weeks). Conjunctival impression cytology was performed before and 24 weeks after transplantation. Finally, a histological analysis of the cornea, conjunctiva, and transplanted grafts was performed. RESULTS. At inclusion (n ¼ 8) the mean Schirmer test was 1.31 6 0.53 mm, the mean fluorescein score was 4.7 6 1.65, and the mean lissamine green staining was 4.38 6 0.48. After transplantation, a significant increase in tear secretion was observed with the mean Schirmer test results in group 2 significantly higher than those observed for group 1 at all time points (P < 0.05). Similarly, fluorescein and lissamine green scores were significantly lower in group 2 than in group 1 at all time points after transplantation (P < 0.05). Impression cytology specimens showed severe conjunctival squamous metaplasia without goblet cells in both groups. Under light microscopy, no significant difference was observed between the cornea and the conjunctiva of the two groups. CONCLUSIONS. Labial salivary gland transplantation provided a basal secretion of tears and improved ocular surface staining scores during the first 3 months in a severe rhesus monkey model of dry eye. However, this was not accompanied by major improvement of ocular surface tissues.
Mucous Membrane Grafting For Lid Margin Keratinization in Stevens–Johnson Syndrome: Results
Cornea, 2010
To study the efficacy of mucous membrane grafting as a surgical technique to address lid margin keratinization, an important cause for chronic blink-related microtrauma in Stevens-Johnson syndrome (SJS). Methods: The keratinized strip of conjunctiva along the lid margin was excised and replaced by lip mucous membrane using fibrin glue in 54 eyes of 31 patients with lid margin keratinization after SJS. This was a retrospective case series carried out between April 2005 and November 2006. Results: In 50 of 54 eyes (92.6%), there was improvement or stabilization in patient comfort, conjunctival hyperemia, ocular surface staining characteristics, and best-corrected visual acuity over a mean follow-up period of 6 months. Conclusions: The authors describe the method of mucous membrane grafting for addressing lid margin keratinization, one of the important causes for persistent inflammation in SJS. This procedure not only improves patient comfort and visual acuity by reducing surface inflammation but also possibly prevents further deterioration of ocular surface in SJS.
Skin-Graft in a Case of Total Symblepharon
1965
MANAGEMENT of conjunctival ulceration in the acute stages following chemical injuries and certain infectious diseases is one of the most difficult problems confronting ophthalmic surgeons. This is challenging, more so when the internal structures of the eyeball are not affected. The cornea may be fairly normal in many such cases. Severe damage to the conjunctiva, unless properly treated, will lead to scarring, adhesions, and blindness. However, once the conjunctiva is destroyed, partial restoration of vision can be obtained by lining the conjunctival sac with some of the available replacement tissue, i.e., oral mucosa, homografts of conjunctiva, prepuce, labia minora, split skin-grafts, autografts of conjunctiva,
Severe dry eye associated with Steven Johnson Syndrome: A case report
IP International Journal of Ocular Oncology and Oculoplasty, 2021
Stevens-Johnson-Syndrome (SJS), and its severe variant, toxic epidermal necrolysis (TEN), are life-threatening diseases of skin and mucous membranes. Cases with pseudo-membrane formation and epithelial defects, have higher risk of ocular sequelae. Severe dry eye in SJS includes three mechanisms: (1) aqueous tear deficiency, (2) decreased wettability of corneal surface, and (3) increased evaporation. Observation: A 47-year-old male patient presented in OPD with chief complaint of severe discomfort and grittiness in both eyes since last 21 years. Proper history taking and examination was done. Patient was given conservative treatment and was explained about recent advancements of treatment that can help in improving his condition. Conclusion: In SJS patients, dryness causes eye pain, and unstable tear film causes diminution of vision. After acute stage reactions, visual impairment and severe dry eye are observed as ocular sequelae.
Cornea, 2013
To evaluate tear osmolarity with the recently introduced TearLab system (TearLab Corporation, San Diego, USA) in patients with non-Sjögren syndrome dry eye (NSSDE), Sjögren syndrome dry eye (SSDE) and in healthy subjects, and to compare the results to those from classical dry eye tests. Patients and methods: 39 eyes of 21 patients with NSSDE, 39 eyes of 20 patients with SSDE and 44 eyes of 22 healthy individuals were enrolled in the study. Tear osmolarity was measured with the TearLab system, LIPCOF score was examined with slit-lamp, then the classical diagnostic tests such as Schirmer I test, tear break-up time (BUT) and corneal staining were carried out followed by the examination of meibomian glands and corneal transparency. Results: Mean tear osmolarity was 296.77±16.48 mOsms/L in NSSDE (15% abnormal), 303.36±17.22 mOsms/L in SSDE (23% abnormal) and 303.52±12.92 mOsms/L in the control group (16% abnormal) (P=0.018, Kruskal-Wallis). Schirmer test, corneal staining, BUT and m e i b o m i a n g l a n d s t a t u s w e r e s i g n i f i c a n t l y d i f f e r e n t i n t h e t w o p a t i e n t s g r o u p s w h e n compared to the healthy individuals (P<0.0001). In the control and SSDE groups, no significant correlation was disclosed between tear osmolarity and any of the performed dry eye tests (P>0.05, Spearman).