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José A. P. Gomes, MD; Myrna S. Santos, MD; Ângela S. Ventura, MD; Waleska B. C. Donato, MD; Marcelo C. Cunha, MD; Ana Luísa Höfling-Lima, MD

Arch Ophthalmol. 2003;121:1369-1374.

Objective  To report the use of preserved amniotic membrane and living related corneal limbal/conjunctival transplantation in total limbal stem cell and conjunctival deficiency secondary to severe Stevens-Johnson syndrome.

Design  Prospective, noncomparative, interventional case series.

Patients and Methods  Ten eyes of 10 patients with total limbal stem cell and conjunctival deficiency secondary to Stevens-Johnson syndrome underwent excision of cicatricial tissue followed by amniotic membrane and living related corneal limbal/conjunctival transplantation.

Main Outcome Measures  Reconstruction of corneal epithelium (clear appearance without epithelial defect, normal fluorescein permeability, and the absence of conjunctiva-derived goblet cells on impression cytologic testing), decrease in corneal vascularization, and improvement in visual acuity.

Results  During a mean follow-up of 16.7 months, satisfactory ocular surface reconstruction was obtained in 2 eyes (20%), with reduced inflammation and vascularization and a mean epithelialization time of 3 weeks. Surgical failure was observed in 4 cases (40%) and complications (infection) in 4 cases (40%). Visual acuity improved in 4 eyes (40%), remained stable in 5 eyes (50%), and decreased in 1 eye (10%).

Conclusions  Amniotic membrane and living related corneal limbal/conjunctival transplantation were successful in 20% of severe cases of total limbal stem cell and conjunctival deficiency secondary to Stevens-Johnson syndrome. A high proportion of postoperative complications, in particular, infection, seemed to jeopardize a favorable outcome.

From the Department of Ophthalmology, Paulista School of Medicine/Federal University of São Paulo, São Paulo, Brazil. The authors have no relevant financial interest in this article.

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