Sutureless Amniotic Membrane Transplantation Using Pediatric Nasogastric Tube For Patients With Acute Stevens-Johnson Syndrome/ Toxic Epidermal Necrolysis

Evaluation of the results of sutureless amniotic membrane transplantation (AMT) using a pediatric nasogastric tube (NGT) for patients with acute Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis (SJS/TEN) was aimed.

Single tertiary care referral hospital (Basaksehir Cam and Sakura City Hospital)

Twenty-six eyes of 13 patients with SJS/TEN who had ocular involvement and were admitted to the ophthalmology department of a single tertiary care hospital between May 2020 – March 2022 were included in the study. An amniotic membrane was implanted onto the ocular surface and into the conjunctival fornices using a pediatric NGT with both ends attached. Patients were followed for at least 6 months. The mean duration of the surgery was recorded. The presence of corneal defect and vascularization, meibomian gland dysfunction grade, conjunctival scarring, tarsal keratinization, symblepharon, and trichiasis were recorded.

The mean age of the patients was 38.4±17.6 years (range: 6-62 years). Ten (76.9%) patients were female and 3 (23.1%) patients were male. AMT was performed only once for 8 patients and twice for 5 patients. The mean duration of the surgery was 3.2±0.4 minutes. NGT was removed 28 days after its application. At the first examination, 20 eyes (76.9%) had a corneal epithelial defect, 6 (23.1%) had early symblepharon.  At the postoperative 6 months, although 4 eyes (15.4%) had conjunctival scarring and tarsal keratinization, all patients were without any corneal defect, corneal vascularization, or symblepharon. Only 4 eyes (15.4%) showed grade 3 MGD and 1 eye (0.04%) showed trichiasis.

Within the limitations of this retrospective study, we showed that sutureless AMT using pediatric NGT could be a potentially fast and inexpensive treatment option for the treatment of SJS/TEN with ocular involvement without the need for general anesthesia. However, future prospective randomized controlled studies or cost-effectivity studies utilizing a larger patient cohort are needed for a better understanding of its efficiency.