Amniotic membrane application in acute stage offers value to SJS/TENS patients

Application of amniotic membrane to the ocular surface in theacute stage appears to be having a favorable impact on theophthalmic prognosis for patients who survive Stevens-JohnsonSyndrome/toxic epidermal necrolysis syndrome (SJS/TENS), saidKimberly C. Sippel, MD, assistant professor of ophthalmology,Weill Cornell Medical College, New York.

"We apply amniotic membrane as soon as possible when patientspresent to our burn unit, and case reports and case series reportimpressive results with this strategy," Dr. Sippel said."However, additional studies are needed to truly assess theefficacy of amniotic membrane application, and for true progressto be made in addressing the ocular sequelae of these disorders,we need a therapy that actually aborts the immune-mediated attackon the ocular surface."

The rationale for amniotic membrane application is to providecoverage and aid epithelialization of denuded mucosal surfaces,although some evidence shows that the membrane also hasanti-inflammatory effects. The goal of application is to coverthe entire ocular surface, including the eyelid margins,palpebral and bulbar conjunctival surfaces, and the cornea.

The application involves two stages. First, a sheet of amnioticmembrane is applied to cover the lid margins and tarsalconjunctiva, and then a second sheet is used to cover the cornea.Although the procedure generally is done in the operating room,it can be completed at the bedside in these critically illpatients using various modifications for the second stage.

"Ophthalmic treatment for patients with SJS and TENS hastraditionally been supportive in nature, but these measures dolittle to improve the ophthalmic prognosis," Dr. Sippel said."Intervention in the acute stage is key."