Abstract
Background: We describe our complex surgical techniques in the management of a patient with end-stage ocular surface disease from Stevens–Johnson syndrome.
Methods and results: Her severe discomfort due to absolute ocular dryness in the right eye was successfully treated with submandibular gland autotransplantation. Impending loss of the left eye due to repeated perforation and infection was prevented with a penetrating corneal graft covered by a new modification of a Cutler-Beard-type full-thickness lower lid skin advancement-flap. Visual rehabilitation was achieved by means of osteo-odonto-keratoprosthesis.
Conclusion: The procedures described allow the preservation of eyes doomed for enucleation, relief from severe discomfort and rehabilitation from corneal blindness. Due to their complex nature they require the collaborative subspecialist surgical skills of opthalmologists and maxillofacial surgeons.
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References
Howard GM . The Stevens–Johnson syndrome. Ocular prognosis and treatment. Am J Ophthalmol 1963; 55: 893–900.
Tsubota K, Satake Y, Ohyama M, Toda I, Takano Y, Ono M et al. Surgical reconstruction of the ocular surface in advanced ocular cicatricial pemphigoid and Stevens–Johnson syndrome [see comments]. Am J Ophthalmol 1996; 122(1): 38–52.
Geerling G, Sieg P, Bastian GO, Laqua H . Transplantation of the autologous submandibular gland for most severe cases of keratoconjunctivitis sicca. Ophthalmology 1998; 105(2): 327–335.
Hull CC, Liu CSC . Towards an improved visual field in the osteo-odonto keratoprosthesis. Ophthalmic Physiol Opt 1998; 18: 382.
Tugal-Tutkun I, Akova YA, Foster CS . Penetrating keratoplasty in cicatrizing conjunctival diseases. Ophthalmology 1995; 102(4): 576–585.
Chiou AG, Florakis GJ, Kazim M . Management of conjunctival cicatrizing diseases and severe ocular surface dysfunction. Surv Ophthalmol 1998; 43(1): 19–46.
Poon AJ, Geerling G, Dart JKG GEF. Autologous serum eyedrops for dry eyes and epithelial defects: clinical and in-vitro toxicity studies. Br J Ophthalmol, 2001; 85: 1188–1197.
Mauriello Jr JA, Pokorny K . Use of split-thickness dermal grafts to repair corneal and scleral defects—a study of 10 patients [see comments]. Br J Ophthalmol 1993; 77(6): 327–331.
Heiligenhaus A, Shore JW, Rubin PA, Foster CS . Long-term results of mucous membrane grafting in ocular cicatricial pemphigoid. Implications for patient selection and surgical considerations. Ophthalmology 1993; 100(9): 1283–1288.
Alino AM, Perry HD, Kanellopoulos AJ, Donnenfeld ED, Rahn EK . Conjunctival flaps [see comments]. Ophthalmology 1998; 105(6): 1120–1123.
Marchi V, Ricci R, Pecorella I, Ciardi A, Di Tondo U . Osteo-odonto-keratoprosthesis. Cornea 1994; 13(2): 125–130.
Dohlman CH, Terada H . Keratoprosthesis in pemphigoid and Stevens–Johnson syndrome. Adv Exp Med Biol 1998; 438: 1021–1025.
Acknowledgements
This work received its funding from the German Research Council (DFG: Ge 895/4-1), the Special Trustees of Moorfields Eye Hospital and the NHS executive. The views expressed in this publication are those of the authors and not necessarily those of the funding bodies' executives.
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Geerling, G., Liu, C., Dart, J. et al. Sight and comfort: complex procedures in end-stage Stevens–Johnson syndrome. Eye 17, 89–91 (2003). https://doi.org/10.1038/sj.eye.6700264
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DOI: https://doi.org/10.1038/sj.eye.6700264
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