Table 2 Literature review of the ophthalmologic management of ocular sequelae in SJS/TEN
Treatments | Author/(Ref) | Year | Methodology of the study | Number of patients | Conclusion |
|---|---|---|---|---|---|
Local treatments | |||||
Artificial tears | Saeed HN et al. [3] | 2016 | Literature review | Unknown | Instillation of preservative-free artificial tears is necessary and recommended to increase their volume while preserving the ocular surface |
Vitamin A Ointment (VA) | Soong HK et al. [16] | 1988 | Multicentric randomized controlled | 116 (EN = 24) | Study of the effect of (VA) (0.01%) versus placebo in patients with scarring conjunctivitis. Significant regression of conjunctival keratinization after application of VA. However, clinical symptoms and signs did not show significant improvement with the active drug compared to placebo |
Corticosteroid eye drops | Kohanim S et al. [17] | 2016 | Meta-analysis | Unknown | Not recommended for long-term use; limited data, known harmful side effects. Short-term anti-inflammatory |
Prabhasawat P et al. [18] | 2013 | Prospective interventional comparative | 30 | Analysis of data from 30 patients with EN complicated by severe dry eye syndrome and treated with cyclosporin 0.05% 2 times a day for 6 months. Evaluation of dry eye symptoms, redness, break up time, fluorescein examination and Schirmer test before and after treatment (2, 4 and 6 months) Cyclosporine 0.05% eye drops may be beneficial in the treatment of chronic dry eye associated with SJS. 8 were excluded for poor tolerance and 5 were lost to follow-up. The remaining 17 cases all showed significant improvement in dry eye symptoms, conjunctival injection, superficial punctate keratitis (SPK), Schirmer's test (p < 0.05). Poor tolerance was manifested by pain, palpebral edema, ocular redness which could lead to discontinuation of treatment | |
Wan KH et al. [19] | 2015 | Meta-analysis | 1367 | 12 randomized controlled trials were analyzed to assess the efficacy of topical cyclosporin 0.05% treatment compared to a control group in dry eye syndromes (all causes including SJS). Compared to controls, patients receiving cyclosporine had significantly lower Ocular Surface Disease Index (OSDI) scores (p = 0.04), longer break up time (p = 0.04), improved Schirmer's score (p < 0.0001), reduced corneal fluorescein uptake (p = 0.03), and higher ocular surface red blood cell density (p = 0.004) | |
Antibiotics/antiseptics eye drops | Kittipibul T et al. [21] | 2020 | Prospective comparative study | 40 | A significantly higher proportion of various pathogenic microorganisms (mainly Pseudomonas aeruginosa, Staphylococcus aureus, Streptococcus and Acinetobacter) was found in EN (60%, vs. 10% in controls, p = 0.001) The use of local antibiotics must be appropriate and must be discussed on a case-by-case basis |
Autologous serum 20% eye drops | Poon AC et al. [22] | 2001 | Prospective comparative clinical pilot study | 26 eyes of 22 patients | Autologous serum was used in 15 eyes of 13 patients with resistant epithelial defects and in 11 eyes of nine patients with keratoconjunctivitis. The beneficial effect may be related to a number of active factors in the serum, including growth factors, fibronectin, vitamin A, and anti-proteases. In vitro toxicity testing showed that serum drops reduced toxicity compared with preservative-free eye drops. Their use in routine practice remains difficult |
Topical tacrolimus | Lee YJ et al. [24] | 2013 | Retrospective consecutive case series | Unknown | Topical corticosteroids were left on continuously to control persistent and recurrent inflammation in SJS despite the introduction of tacrolimus |
Systemic treatments | |||||
(cyclosporine, azathioprine, cyclophosphamide, methotrexate, mycophenolate, dapsone andinfliximab) | Saeed HN et al. [3] Kohanim S et al. [17] | Systemic immunosuppression should be considered in cases of recurrent or persistent inflammation or perioperatively to control inflammation in preparation for and after ocular surgery | |||
Eyelid treatments | |||||
Oral mucosa transplant (OMT) | Osaki TH et al. [25] | 2018 | Meta-analysis | 44 patients 63 eyelid (EN = 40) | The use of oral mucosa as a posterior flap transplant showed good functional and cosmetic results, long-term stability, and a low recurrence rate in the treatment of severe scarring entropion of the upper eyelid. Retrospective chart review of patients who underwent tarsotomy combined with OMT to treat severe upper eyelid scarring entropion. The primary underlying diagnosis was SJS (63%). Complete resolution (restoration of the upper eyelid margin to normal anatomic position with good cosmetic appearance) was achieved in 52 lids (83%). Recurrence occurred in 7 eyelids (11%) |
Fu Y et al. [28] | 2011 | Retrospective, interventional case series | 22 (EN = 10) | Improvement in visual acuity in 13 eyes (59.1%) of patients after eyelid surgery | |
Amniotic Membrane Transplantation (AMT) | Kheirkhah A et al. (26) | 2013 | Retrospective study | In the case of severe symblepharon, an approach combining scar lysis, mitomycin application, OMT associated with sutureless AMT was a safe and effective technique for fornix reconstruction. In no case is AMT a substitute for OMT | |
Adjuvant treatments | |||||
Subconjunctival anti- VEGF | Gueudry J et al. [31] | 2010 | Prospective study | 13 eyes of 12 patients | Evaluation of the efficacy and tolerance of subconjunctival anti VEGF in 13 eyes. The percentage of corneal neovascularization to total corneal area decreased from 41.1 to 33.7% at day 45 (p = 0.0003) after an average of 2 to 4 injections. Visual acuity was not improved. Subconjunctival anti-VEGF injections decreased corneal neovascularization, with no significant improvement in visual acuity at 4 months. (All cases of corneal neovascularization) |
Scleral lenses | Tougeron-Brousseau B et al. [9] | 2009 | Retrospective study | 53 eyes of 42 patients | The use of scleral lenses was effective and safe for visual rehabilitation. A progression in visual acuity from 0.73 to 0.50 log (p = 0.0001) 6 months after scleral lens placement was shown. The mean Ocular Surface Disease Index (OSDI) improved from 76.9 22.8 to 37.1 26.7 (p = 0.0001). All patients included had a history of EN |
Sotozono C et al. [32] | 2014 | Retrospective study | 94 eyes | Evaluation of the therapeutic benefits of scleral lenses in patients with ocular sequelae associated with EN. SL are safe and effective in improving vision and quality of life in EN patients with severe ocular sequelae | |
Limbal stem cell transplant | Venugopal R et al. [26] | 2021 | Prospective study | 41 patients | Evaluation of Cultivated oral mucosal epithelial transplantation (COMET) in 41 patients with chronic EN sequelae. The evolution of corrected visual acuity, severity scores of various ocular surface parameters and the occurrence of complications were documented during a 2-year follow-up period. 82% of eyes (37/45) improved in visual acuity, 13% (6/45) had no change, while 2 eyes (4%) worsened in visual acuity. Two eyes developed persistent epithelial defects, with progression to corneal melting requiring keratoplasty |
Amniotic Membrane Transplantation (AMT) | Yang Y et al. [35] | 2021 | Meta-analysis | 41 patients | The amniotic membrane is used after the removal of the symblepharon. However, in end-stage EN, the effect of AMT is limited in corneal ulcers. Its effect is mostly recognized in the acute phase |
Keratoplasty Penetrating keratoplasty (PK) | Wang F et al. [36] | 2014 | Retrospective study | 10 eyes | Study of 10 SJS eyes. Penetrating keratoplasty was reserved for certain cases of corneal perforation, associating a patch graft with a conjunctival covering. Visual acuity improved in six eyes (60%), remained unchanged in three eyes (30%) and decreased in one eye (10%) |
Osteodontokerato-prosthesis OOKP | Tan A et al. [38] | 2012 | Meta-analysis | 96 patients | Main indications: EN and severe burns (96 EN). Anatomical survival in all OOKP studies was excellent, with a survival rate of over 80%, even after 20 years. Most frequent complications were: Glaucoma (47.2%) with difficulties in follow-up/management and postoperative vitreous hemorrhage but resolved within the first postoperative week in general. Need for specialized centers |