Outcome of sutureless amniotic membrane dressing ring for acute Stevens-Johnson syndrome with severe ocular involvement: A case report of 5 patients

Abstract

Rationale: Stevens-Johnson Syndrome (SJS) and toxic epidermal necrolysis can lead to severe ocular damage and long-term vision complications. Our self-made sutureless amniotic membrane dressing (AMD) ring leverages the anti-inflammatory and regenerative properties of the amniotic membrane (AM), promoting healing, reducing scarring, and enhancing patient comfort.

Patient concerns: Five consecutive patients (3 females, 2 males; aged from 18 to 53 years) with acute SJS/TEN were at immediate risk of significant ocular surface damage, including corneal and conjunctival epithelial defects and eyelid margin erosions, which can progress to chronic dry eye, scarring, or permanent vision loss without timely intervention.

Diagnoses: All patients were diagnosed with SJS/TEN based on their clinical presentations, including acute onset of mucocutaneous eruptions and extensive epidermal detachment, and comprehensive histories, confirmed by a dermatologist. Ocular involvement was assessed through detailed ophthalmologic examination and classified using the Sotozono grading system.

Interventions: A self-made AMD ring, inspired by commercially available products such as Prokera, was used to cover the ocular surface. Constructed from readily available materials, this ring provides therapeutic benefits similar to Prokera without the need for suturing.

Outcomes: High epithelial healing rates and stable follow-up visual acuity underscore this technique's potential efficacy in selected SJS/TEN cases with severe ocular involvement.

Lessons: Early and accessible interventions are essential for managing SJS/TEN-related ocular complications. The self-made AMD ring is a cost-effective and minimally invasive option that shows potential as an alternative to commercial AM devices, particularly in settings where availability or affordability is limited. Further research with larger cohorts is warranted to confirm its efficacy.

Keywords: Stevens–Johnson syndrome; amniotic membrane dressing; ocular surface damage; toxic epidermal necrolysis.