Mucous Membrane Grafting For Lid Margin Keratinization in Stevens–Johnson Syndrome: Results

Abstract

The authors describe the method of mucous membrane grafting for addressing lid margin keratinization, one of the important causes for persistent inflammation in SJS. This procedure not only improves patient comfort and visual acuity by reducing surface inflammation but also possibly prevents further deterioration of ocular surface in SJS.

Treatment Modalities and Clinical Outcomes in Ocular Sequelae of Stevens–Johnson Syndrome Over 25 Years—A Paradigm Shift

“…Subgroup A included procedures for surface stabilization and fornix reconstruction that included punctal occlusion (collagen or silicone plugs), adnexal corrective procedures, symblepharon release with amniotic membrane grafting in group I and punctal cautery, MMG for lid margin keratinization, prosthetic replacement of ocular surface ecosystem (PROSE) lenses, symblepharon release with amniotic membrane grafting and MMG to the lids, cultivated oral mucosal epithelial transplantation, and adnexal corrective procedures in group II. 12,13 Procedures for visual rehabilitation were categorized under subgroup B that included limbal allograft with penetrating keratoplasty with systemic azathioprine (2 mg/ kg) for 6 months to 1 year in group I and cataract extraction/ optical iridectomy/keratoprosthesis in group II. Procedures for ocular surface stabilization and PROSE lenses were used to further improve the visual acuity for eyes that underwent cataract extraction and optical iridectomy.…”

“…MMG for lid margin keratinization definitely has a role to play not only in improving patient comfort, the ocular surface status, and visual acuity but also in preventing a deterioration of the ocular surface. 12,13 The associated dryness, another important cause for persistent inflammation in these eyes, needs aggressive management. Punctal cautery alone, in the presence of a patent nasolacrimal duct, in a moderate to severe dry eye, improved/ stabilized the visual acuity along with an improvement of the ocular surface status in more than 90% of the eyes.…”

“…Over the last decade, lid margin keratinization, a feature that occurs in most eyes of patients with SJS, was identified as an important cause for the continued inflammation of the ocular surface and possibly, therefore, for the worsening of limbal status as well. 10,11 The need to address the same was highlighted, and we published our initial results of the impact of mucous membrane grafting (MMG) for lid margin keratinization in 54 eyes of 31 patients 12 and, subsequently, reported the results of comprehensive management of SJS. 13 Before the understanding of a comprehensive approach in these eyes, the management of the ocular sequelae in patients with SJS was primarily limited to the use of topical lubricants, topical steroids, punctal occlusion, tectonic procedures, attempts at fornix reconstruction, and limbal allografts.…”

Severe Dry Eye With Combined Mechanisms is Involved in the Ocular Sequelae of SJS/TEN at the Chronic Stage

“…40 Moreover, oral mucus membrane grafts can be used for fornix reconstruction and tarsal conjunctival scarring. 41,42 Minor salivary glands transplantation was found to improve dry eye in SJS. 42 We also developed autologous cultivated oral mucosal epithelial transplantation (COMET).…”

Oral Mucosal Grafts: Old Technique in New Light

“…For reconstruction of the lid margin, oral mucosal graft can correct trichiasis and entropion. Recently, Iyer et al [18] used mucous membrane grafting for correcting lid margin keratinization in Stevens-Johnson syndrome to reduce ocular surface inflammation and to improve patient comfort and visual acuity. However, their study excluded severe cases with extensive symblepharon, entropion, ocular surface cicatrization, and severe dry eye.…”