Prompt versus delayed amniotic membrane application in a patient with acute Stevens-Johnson syndrome.
Prompt versus delayed amniotic membrane application in a patient with acute Stevens-Johnson syndrome.
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DOI：
10.2147/opth.s45054
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发表时间：
2013
期刊：
影响因子：
--
通讯作者：
Sippel KC
中科院分区：
文献类型：
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作者：
Ciralsky JB;Sippel KC
史蒂文斯-约翰逊综合征常伴有致盲性眼表瘢痕后遗症。最近的报道已经描述了在急性期应用羊膜到眼表明显改善临床结果。在这里，我们描述了急性史蒂文斯-约翰逊综合征和严重眼表受累患者的临床结果，其中不断发展的医疗条件和家庭同意导致羊膜应用于每只眼睛在不同的时间间隔从疾病发作。我们对一位在发病数小时内出现的史蒂文斯-约翰逊综合征的妇女进行了回顾性的图表回顾。她在超急性期（发病后<72小时）将羊膜应用于左眼眼表，在急性期（发病后6天）较晚的时间点将羊膜应用于右眼。两眼的临床结果，以及相关的眼部症状，在一年的术后期间进行比较。右眼在病程后期接受治疗，需要额外的外科手术，最终表现出比左眼更严重的眼表病理。此外，患者报告了更明显的慢性眼痛和右眼视力困难问题。在这例史蒂文斯-约翰逊综合征继发的严重眼部受累患者中，早期应用羊膜对眼表进行干预被证明是优越的。发病后尽早应用羊膜，最好在超急性期应用，其临床效果明显好于病程后期应用。
Stevens-Johnson syndrome is often associated with blinding ocular surface cicatricial sequelae. Recent reports have described markedly improved clinical outcomes with the application of amniotic membrane to the ocular surface during the acute phase. Here we describe the clinical outcome of a patient with acute Stevens-Johnson syndrome and severe ocular surface involvement in whom the evolving medical condition and family consent resulted in amniotic membrane application to each eye at differing intervals from disease onset. We undertook a retrospective chart review of a woman with Stevens-Johnson syndrome who presented within hours of disease onset. She underwent application of amniotic membrane to the ocular surface of the left eye during the hyperacute phase (<72 hours after disease onset) and to the right eye at a later time point during the acute phase (six days after disease onset). The clinical outcomes of the two eyes, as well as associated ocular symptoms, were compared over a one-year postoperative period. The right eye, treated later in the course of the disease, required additional surgical procedures and ultimately exhibited significantly more advanced ocular surface pathology than the left. Further, the patient reported more pronounced issues of chronic eye pain and visual difficulties in the right eye. Earlier intervention with application of amniotic membrane to the ocular surface in this patient with severe ocular involvement secondary to Stevens-Johnson syndrome proved superior. Application of amniotic membrane as soon as possible after disease onset, preferably in the hyperacute phase, appears to result in a significantly better clinical outcome than application later in the disease course.