Chronic Ocular Sequelae and Subsequent Surgical Interventions in Stevens-Johnson Syndrome After Amniotic Membrane Transplantation

Purpose: The purpose of this study was to describe the chronic ocular sequelae and subsequent surgical interventions after amniotic membrane transplantation (AMT) in a patient with Stevens-Johnson syndrome (SJS). Methods: A 30-year-old woman was diagnosed with SJS after taking phenytoin prescribed for generalized tonic-clonic seizures. Bedside AMT covering the eyelid margins, the conjunctiva, and the cornea was performed in both eyes during the acute phase during hospitalization. A repeat AMT was necessary after 5 days. After AMT, she was prescribed topical steroids, antibiotics, and artificial tears. She was asked to follow up every 2 weeks in the first 3 months after AMT. Results: Eyelid-related complications such as trichiasis, distichiasis, eyelid margin keratinization (LMK), and cicatricial entropion developed during the follow-up period within the first year after AMT. Eyelid margin mucous membrane graft (MMG) of all eyelids was performed at the earliest clinical sign of lid-related keratopathy due to LMK. The right eye developed upper eyelid and lower eyelid cicatricial entropion, for which anterior lamellar repositioning with eyelid margin MMG was performed. Electroepilation of the trichiatic eyelashes in all 4 eyelids was performed more than once to maintain a healthy ocular surface. Conclusions: Successful AMT was performed twice within the first week of ocular involvement in the acute phase of SJS. Chronic ocular sequelae affecting the eyelid margin were identified during the chronic phase and were successfully treated with eyelid margin MMG. Necessity for the close follow-up and the need for subsequent interventions to maintain visual acuity should be explained to patients after acute SJS with ocular involvement.