- Email: [email protected]
Amniotic membrane transplantation in Stevens-Johnson syndrome
Accepted Manuscript Amniotic membrane transplantation in Stevens-Johnson Syndrome Virgilio Galvis, MD, Alejandro Tello, MD, Christian Laverde, MD, Gisella Santaella, MD, Augusto J. Gómez, MD, Alberto L. Diaz, MD PII:
S0039-6257(16)30149-7
DOI:
10.1016/j.survophthal.2016.10.001
Reference:
SOP 6664
To appear in:
Survey of Ophthalmology
Received Date: 13 August 2016 Accepted Date: 7 October 2016
Please cite this article as: Galvis V, Tello A, Laverde C, Santaella G, Gómez AJ, Diaz AL, Amniotic membrane transplantation in Stevens-Johnson Syndrome, Survey of Ophthalmology (2016), doi: 10.1016/j.survophthal.2016.10.001. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
1
ACCEPTED MANUSCRIPT Title: Amniotic membrane transplantation in Stevens-Johnson Syndrome. Running head: Amniotic membrane in Stevens-Johnson. Virgilio Galvis, MD1,2,3. Alejandro Tello, MD1,2,3. Christian Laverde, MD1. Gisella Santaella, MD1. Augusto J. Gómez, MD3,4. Alberto L. Diaz, MD3,4.
RI PT
Floridablanca, Santander, Colombia.
Centro Oftalmológico Virgilio Galvis, FOSCAL, Floridablanca, Colombia.
2
Universidad Autónoma de Bucaramanga, Bucaramanga, Colombia.
3
Fundación Oftalmológica de Santander-FOSCAL, Floridablanca, Colombia.
SC
1
4
Universidad Industrial de Santander, Bucaramanga, Colombia.
M AN U
This work did not have public or private financial support.
Corresponding Author: Alejandro Tello, MD. Centro Oftalmologico Virgilio Galvis, Centro Medico Ardila Lulle,Torre A, Piso 3, Modulo 7. Floridablanca, Santander, Colombia.
TE D
Email: [email protected].
Financial Disclosure: No author has a financial or proprietary interest in any
AC C
EP
material or method mentioned.
2
ACCEPTED MANUSCRIPT To the Editor: We read with great interest the article “Stevens-Johnson syndrome: The role of an ophthalmologist” by Jain et al 2. Most probably because both articles were submitted to the journals almost at the same time, the review by Jain et al. did
RI PT
not include the only prospective randomized controlled clinical trial evaluating
the adjuvant role of amniotic membrane transplantation (AMT) in cases of acute ocular Stevens-Johnson syndrome (SJS) reported by Sharma et al.3 They
SC
found that none of the 25 eyes in the AMT combined with medical therapy group had corneal haze, limbal stem cell deficiency, symblepharon,
M AN U
ankyloblepharon, or lid-related complications after 6 months of follow-up. On the other hand, 44% of the 25 eyes in the medical therapy group (without AMT) developed corneal haze, and 24% corneal vascularization and conjunctivalization. One eye (4%) in this latter group developed so severe
TE D
symblepharon that presented ankyloblepharon. These findings firmly support the use of amniotic membrane transplantation as an adjunct to conventional medical therapy in maintaining distance corrected visual acuity and a stable
EP
ocular surface in cases of acute ocular SJS and that its use also helps to prevent intermediate-term ocular cicatricial sequelae in those eyes.
AC C
As Jain et al. explained, it is true that there is not prospective studies analyzing the relative role of the timing of AMT in acute SJS, however they missed a retrospective study by Cherof et al. on the topic, who found that the window of opportunity for a significant effect of AMT in acute SJS was very narrow. The authors reviewed 74 eyes of 37 patients with severe ocular involvement treated with AMT and found that those eyes receiving the transplantation beyond the first six days of illness exhibited a higher possibility of presenting decreased
3
ACCEPTED MANUSCRIPT visual acuity, moderate to severe dry eye or moderate tarsal conjunctival scarring.A In addition, recently Gregory reported a prospective case series including 38 eyes with severe or extremely severe ocular involvement in SJS.2 All those
RI PT
eyes received sutured AMT within the first 10 days of presentation, and 60% of those cases were treated with a second application of AMT. After 3 months only one eye had corneal scar, which was peripheral, only 3 eyes had moderate dry
SC
eyes, and none of the eyes had severe dry eye. He stated that the sooner AMT is performed, the more effectively it can prevent the scarring sequelae, and that
M AN U
it does not help after 7 to 10 days of the onset.
In their article initially Jain et al. indicated that it was ideal to perform AMT in an operating room under an operating microscope, however later they denoted that they advocated the use of fibrin glue because it had advantages including a
TE D
shortened surgical time and that the procedure could be performed at the bedside without an operating microscope. It seems to us that the latter affirmation is the right one. Sharma et al. in the group of 25 eyes that received
EP
AMT in their study performed the application of the membrane in that manner: at the bedside under topical anesthesia in the isolation room using a completely
AC C
suture-less technique. They applied fibrin glue over the cornea and conjunctiva, and placed the membrane covering the entire ocular surface up to the conjunctival fornices, and also covering the upper and lower tarsal conjunctiva. A symblepharon ring then was inserted in all cases.3 We think that these sutureless procedures performed outside the operating room might be ideal in these critically ill patients, requiring urgent transplantation of the membrane. Virgilio Galvis
4
ACCEPTED MANUSCRIPT Alejandro Tello Christian Laverde Gisella Santaella Augusto J. Gómez
RI PT
Alberto L. Diaz
Centro Oftalmológico Virgilio Galvis, Floridablanca, Colombia
Universidad Autónoma de Bucaramanga, Bucaramanga, Colombia.
SC
Fundación Oftalmológica de Santander-FOSCAL, Floridablanca, Colombia. Universidad Industrial de Santander, Bucaramanga, Colombia.
M AN U
REFERENCES
1. Gregory DG. New Grading System and Treatment Guidelines for the Acute Ocular Manifestations of Stevens-Johnson Syndrome. Ophthalmology. 2016 Aug;123(8):1653-8. doi: 10.1016/j.ophtha.2016.04.041.
TE D
2. Jain R, Sharma N, Basu S, et al. Stevens-Johnson syndrome: The role of an ophthalmologist. Surv Ophthalmol. 2016 Jul-Aug;61(4):369-99. doi: 10.1016/j.survophthal.2016.01.004.
EP
3. Sharma N, Thenarasun SA, Kaur M, et al. Adjuvant Role of Amniotic Membrane Transplantation in Acute Ocular Stevens-Johnson Syndrome: A
AC C
Randomized Control Trial. Ophthalmology. 2016 Mar;123(3):484-91. doi: 10.1016/j.ophtha.2015.10.027.
Other Cited Material. A. Cherof AM, Cerda AM, Lynch A, et al. Acute Stevens-Johnson syndrome: the effect the timing of amniotic membrane transplantation has on the occurrence of significant ocular sequelae. Presented at: AAO Annual Meeting, November 16,
5
ACCEPTED MANUSCRIPT 2015; Las Vegas. Available at: http://aao.scientificposters.com/epsAbstractAAO.cfm?id=2. Accessed 13
AC C
EP
TE D
M AN U
SC
RI PT
August, 2016.
S0039-6257(16)30149-7
DOI:
10.1016/j.survophthal.2016.10.001
Reference:
SOP 6664
To appear in:
Survey of Ophthalmology
Received Date: 13 August 2016 Accepted Date: 7 October 2016
Please cite this article as: Galvis V, Tello A, Laverde C, Santaella G, Gómez AJ, Diaz AL, Amniotic membrane transplantation in Stevens-Johnson Syndrome, Survey of Ophthalmology (2016), doi: 10.1016/j.survophthal.2016.10.001. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
1
ACCEPTED MANUSCRIPT Title: Amniotic membrane transplantation in Stevens-Johnson Syndrome. Running head: Amniotic membrane in Stevens-Johnson. Virgilio Galvis, MD1,2,3. Alejandro Tello, MD1,2,3. Christian Laverde, MD1. Gisella Santaella, MD1. Augusto J. Gómez, MD3,4. Alberto L. Diaz, MD3,4.
RI PT
Floridablanca, Santander, Colombia.
Centro Oftalmológico Virgilio Galvis, FOSCAL, Floridablanca, Colombia.
2
Universidad Autónoma de Bucaramanga, Bucaramanga, Colombia.
3
Fundación Oftalmológica de Santander-FOSCAL, Floridablanca, Colombia.
SC
1
4
Universidad Industrial de Santander, Bucaramanga, Colombia.
M AN U
This work did not have public or private financial support.
Corresponding Author: Alejandro Tello, MD. Centro Oftalmologico Virgilio Galvis, Centro Medico Ardila Lulle,Torre A, Piso 3, Modulo 7. Floridablanca, Santander, Colombia.
TE D
Email: [email protected].
Financial Disclosure: No author has a financial or proprietary interest in any
AC C
EP
material or method mentioned.
2
ACCEPTED MANUSCRIPT To the Editor: We read with great interest the article “Stevens-Johnson syndrome: The role of an ophthalmologist” by Jain et al 2. Most probably because both articles were submitted to the journals almost at the same time, the review by Jain et al. did
RI PT
not include the only prospective randomized controlled clinical trial evaluating
the adjuvant role of amniotic membrane transplantation (AMT) in cases of acute ocular Stevens-Johnson syndrome (SJS) reported by Sharma et al.3 They
SC
found that none of the 25 eyes in the AMT combined with medical therapy group had corneal haze, limbal stem cell deficiency, symblepharon,
M AN U
ankyloblepharon, or lid-related complications after 6 months of follow-up. On the other hand, 44% of the 25 eyes in the medical therapy group (without AMT) developed corneal haze, and 24% corneal vascularization and conjunctivalization. One eye (4%) in this latter group developed so severe
TE D
symblepharon that presented ankyloblepharon. These findings firmly support the use of amniotic membrane transplantation as an adjunct to conventional medical therapy in maintaining distance corrected visual acuity and a stable
EP
ocular surface in cases of acute ocular SJS and that its use also helps to prevent intermediate-term ocular cicatricial sequelae in those eyes.
AC C
As Jain et al. explained, it is true that there is not prospective studies analyzing the relative role of the timing of AMT in acute SJS, however they missed a retrospective study by Cherof et al. on the topic, who found that the window of opportunity for a significant effect of AMT in acute SJS was very narrow. The authors reviewed 74 eyes of 37 patients with severe ocular involvement treated with AMT and found that those eyes receiving the transplantation beyond the first six days of illness exhibited a higher possibility of presenting decreased
3
ACCEPTED MANUSCRIPT visual acuity, moderate to severe dry eye or moderate tarsal conjunctival scarring.A In addition, recently Gregory reported a prospective case series including 38 eyes with severe or extremely severe ocular involvement in SJS.2 All those
RI PT
eyes received sutured AMT within the first 10 days of presentation, and 60% of those cases were treated with a second application of AMT. After 3 months only one eye had corneal scar, which was peripheral, only 3 eyes had moderate dry
SC
eyes, and none of the eyes had severe dry eye. He stated that the sooner AMT is performed, the more effectively it can prevent the scarring sequelae, and that
M AN U
it does not help after 7 to 10 days of the onset.
In their article initially Jain et al. indicated that it was ideal to perform AMT in an operating room under an operating microscope, however later they denoted that they advocated the use of fibrin glue because it had advantages including a
TE D
shortened surgical time and that the procedure could be performed at the bedside without an operating microscope. It seems to us that the latter affirmation is the right one. Sharma et al. in the group of 25 eyes that received
EP
AMT in their study performed the application of the membrane in that manner: at the bedside under topical anesthesia in the isolation room using a completely
AC C
suture-less technique. They applied fibrin glue over the cornea and conjunctiva, and placed the membrane covering the entire ocular surface up to the conjunctival fornices, and also covering the upper and lower tarsal conjunctiva. A symblepharon ring then was inserted in all cases.3 We think that these sutureless procedures performed outside the operating room might be ideal in these critically ill patients, requiring urgent transplantation of the membrane. Virgilio Galvis
4
ACCEPTED MANUSCRIPT Alejandro Tello Christian Laverde Gisella Santaella Augusto J. Gómez
RI PT
Alberto L. Diaz
Centro Oftalmológico Virgilio Galvis, Floridablanca, Colombia
Universidad Autónoma de Bucaramanga, Bucaramanga, Colombia.
SC
Fundación Oftalmológica de Santander-FOSCAL, Floridablanca, Colombia. Universidad Industrial de Santander, Bucaramanga, Colombia.
M AN U
REFERENCES
1. Gregory DG. New Grading System and Treatment Guidelines for the Acute Ocular Manifestations of Stevens-Johnson Syndrome. Ophthalmology. 2016 Aug;123(8):1653-8. doi: 10.1016/j.ophtha.2016.04.041.
TE D
2. Jain R, Sharma N, Basu S, et al. Stevens-Johnson syndrome: The role of an ophthalmologist. Surv Ophthalmol. 2016 Jul-Aug;61(4):369-99. doi: 10.1016/j.survophthal.2016.01.004.
EP
3. Sharma N, Thenarasun SA, Kaur M, et al. Adjuvant Role of Amniotic Membrane Transplantation in Acute Ocular Stevens-Johnson Syndrome: A
AC C
Randomized Control Trial. Ophthalmology. 2016 Mar;123(3):484-91. doi: 10.1016/j.ophtha.2015.10.027.
Other Cited Material. A. Cherof AM, Cerda AM, Lynch A, et al. Acute Stevens-Johnson syndrome: the effect the timing of amniotic membrane transplantation has on the occurrence of significant ocular sequelae. Presented at: AAO Annual Meeting, November 16,
5
ACCEPTED MANUSCRIPT 2015; Las Vegas. Available at: http://aao.scientificposters.com/epsAbstractAAO.cfm?id=2. Accessed 13
AC C
EP
TE D
M AN U
SC
RI PT
August, 2016.