Current ophthalmologic treatment strategies for acute and chronic Stevens-Johnson syndrome and toxic epidermal necrolysis

@article{Ciralsky2013CurrentOT,
  title={Current ophthalmologic treatment strategies for acute and chronic Stevens-Johnson syndrome and toxic epidermal necrolysis},
  author={Jessica B. Ciralsky and Kimberly C Sippel and Darren G. Gregory},
  journal={Current Opinion in Ophthalmology},
  year={2013},
  volume={24},
  pages={321–328}
}
Purpose of review To review the newer, effective ophthalmologic treatments for acute Stevens-Johnson syndrome (SJS) as well as the emerging treatment options for patients with chronic, severe ocular surface damage from the disease. Recent findings Amniotic membrane transplantation (AMT) applied to the eyes and eyelids in the acute phase of SJS can prevent the devastating scarring and visual problems that characterize the chronic phase of the disease. The severity of ocular inflammation in the… 
Ocular manifestations of Stevens–Johnson syndrome and their management
TLDR
The literature overwhelmingly describes acute intervention for ocular involvement in SJS/TEN as improving long-term outcomes, which demonstrates the need for a universal standard of care for patients admitted with the disease.
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TLDR
This study implies that acute manifestation can be an indicator for chronic sequelae and additional early etanercept treatment and early AMT showed beneficial effect in reducing chronic ocular sequela.
Chronic Ocular Complications of Stevens–Johnson Syndrome and Toxic Epidermal Necrolysis: The Role of Systemic Immunomodulatory Therapy
TLDR
The presence of ongoing ocular surface inflammation and progressive conjunctival fibrosis in the absence of exogenous aggravating factors suggest a possible role for systemic immunomodulatory therapy (IMT).
Acute and Chronic Ophthalmic Involvement in Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis - A Comprehensive Review and Guide to Therapy. II. Ophthalmic Disease.
TLDR
It is hoped this effort will assist ophthalmologists in their management of SJS/TEN, so that patients with this complex and debilitating disease receive the best possible care and experience the most optimal outcomes in their vision and quality of life.
Severe Dry Eye With Combined Mechanisms is Involved in the Ocular Sequelae of SJS/TEN at the Chronic Stage.
TLDR
Among 13 slit-lamp microscopy images that were obtained of SJS/TEN patients at the chronic stage, the loss of corneal epithelial stem cells and severe meibomian gland involvement were found to be the most common disorders.
New Grading System and Treatment Guidelines for the Acute Ocular Manifestations of Stevens-Johnson Syndrome.
TLDR
A new grading system facilitates decision making in the evaluation and management of the acute ocular manifestations of SJS and TEN and may be monitored and treated medically if not worsening.
Stevens-Johnson Syndrome, Toxic Epidermal Necrolysis and Other Mucocutaneous Syndromes
TLDR
A comprehensive approach with specific attention to lids and lid margin keratinisation in the chronic phase stabilises the ocular surface and reduces the incidence of corneal complications of the disease which are sight threatening.
Long-term impact of a treatment protocol for acute ocular involvement in Stevens-Johnson syndrome/toxic epidermal necrolysis.
TLDR
A specific protocol for acute ocular care in SJS/TEN, including aggressive use of amniotic membrane transplantation, was highly successful in reducing corneal blindness and severe vision-threatening complications of the disorder.
Comprehensive approach to ocular consequences of Stevens Johnson Syndrome - the aftermath of a systemic condition
TLDR
The ocular sequelae of Stevens Johnson Syndrome need to be identified and addressed early to retard the continued deterioration of the ocular surface and highlight the importance of comprehensive measures in the management of this potentially blinding disorder.
Complications of Stevens-Johnson syndrome beyond the eye and skin.
TLDR
It is believed that preventative care in the acute setting might limit the development and progression of many of the sequelae of SJS/TEN, a multi-organ disease requiring multidisciplinary care from a variety of specialists.
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TLDR
Cryopreserved amniotic membrane application to the ocular surface during the acute phase of Stevens-Johnson syndrome has shown great promise in limiting the destructive inflammation and its long-term sequelae.
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TLDR
In acute SJS and TEN, AMT is an effective treatment for severe ocular surface and eyelid inflammation, greatly decreasing the risk of significant ocular and visual sequelae.
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TLDR
Amniotic membrane coverage of the ocular surface in its entirety coupled with the use of intensive short-term topical corticosteroids during the acute phase of SJS and TEN is associated with the preservation of good visual acuity and an intact ocularsurface.
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This review summarizes recent literature data, showing how sight-threatening corneal complications can progressively develop from cicatricial pathologies of lid margin, tarsus, and fornix at the chronic stage and how such pathologies can be prevented with the early intervention of cryopreserved amniotic membrane transplantation to suppress inflammation and promote epithelial healing at the acute stage.
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TLDR
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TLDR
ProKera placement performed under topical anesthesia may be appropriate for the treatment of ocular surface manifestations of acute SJS particularly in those patients followed in an outpatient setting with milder forms of disease and/or with contraindications to general anesthesia.
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