A successful treatment of Stevens Johnson syndrome by amniotic membrane transplantation using a novel technique
Author: Lipaz Varkel
Base Hospital / Institution: Kaplan Medical Center
ePoster presentation
Abstract ID: 25-205
Purpose
To describe the successful use of a simplified, bedside amniotic membrane transplantation (AMT) technique in a child with acute Stevens-Johnson syndrome (SJS) and severe ocular involvement.
Methods
A 9-year-old healthy girl presented with a two-day history of fever, rhinorrhea, cough, sore throat, rash, and eye discharge. Examination revealed a macular erythematous rash on the face, chest, back, and extremities, including palms and soles. Over the following days, the rash rapidly progressed to vesiculation and epidermal detachment, with oral blisters and necrosis. Skin biopsy confirmed Stevens-Johnson syndrome (SJS).
Ocular examination showed mild eyelid edema, severe conjunctival injection, erosions, and pseudomembranes bilaterally. Initial treatment with topical fluoroquinolone and steroid drops four times daily showed little improvement. Amniotic membrane transplantation (AMT) was performed to preserve ocular surface integrity and prevent long-term complications.
Traditional AMT involves suturing the membrane to the sclera and eyelids under anesthesia, requiring an operating room and microscope. A symblepharon ring is often used to support the fornices. In this case, we used a novel sutureless bedside technique employing a flexible IV-tube ring.
The membrane was affixed to the upper eyelid crease with cyanoacrylate glue, then carefully draped over the conjunctiva and cornea. A flexible IV-tube ring was inserted into the fornices to scaffold and stabilize the membrane, with its lower margin similarly glued to the lower eyelid.
Results
Following AMT, the patient exhibited rapid resolution of ocular inflammation. Six months later, both conjunctiva and cornea remained intact, with only mild superior tarsal conjunctival scarring.
Conclusion
This case highlights the efficacy of a simplified, sutureless AMT technique using an IV-tube ring for acute SJS ocular management. The method is fast, minimally invasive, does not require an operating room or microscope, and may offer an accessible alternative to traditional sutured AMT, especially in urgent or resource-limited settings.
Additional Authors
| First name | Last name | Base Hospital / Institution |
|---|---|---|
| Mor | Schlesinger | Kaplan Medical Center |
| Waleed | Ghannam | Kaplan Medical Center |
| Arie | Marcovich | Kaplan Medical Center |
