Amniotic Membranes Treatments for Acute Phase SJS/TENS Symptoms Act as a “Biological Bandaid”
Doctors have agreed that patients have a better chance at preventing long-term damage to their eyes when their symptoms are treated during the acute phase (first two weeks) of Stevens-Johnson syndrome (SJS) and Toxic Epidermal Necrolysis (TENS).
“The first two weeks of the illness is when treatment will be most effective,” Darren Gregory, M.D., associate professor, University of Colorado Hospital and Rocky Mountain Lions Eye Institute, says.
Gregory prefers to use amniotic membrane in its cryopreserved form to act as a sort of bandage to place over the surface of the eye. He calls it a “biological bandage.” To date, Gregory has treated more than a dozen people with this amniotic membrane. When the treatments were given to patients early on, he found that none of his patients developed any serious eye problems.
While he admits that the amniotic membranes don’t completely get rid of every possible problem that could come up, they were able to prevent tragedies like blindness. This method doesn’t work well in preventing damage if used passed the acute phase, however.
Kimberly C. Sippel, M.D., assistant attending ophthalmologist, New York-Presbyterian Hospital, and assistant professor of ophthalmology, Weill-Cornell Medical College, also approves of using the amniotic membrane treatments.
“What basically happens is you get this sloughing of cells of mucosal surfaces, including the conjunctival surface,” she says. “There is a good likelihood of symblepheron. The causative inflammation can affect the limbal stem cells, which affects the cornea. Once those limbal stem cells are destroyed, the patient will have chronic corneal abrasions.”
Sippel also likes to use steroids when aggressive treatment is needed.
“We use topical in the first few days, only for a brief time, and a very intense regimen,” Sippel adds. “We’ve had good results with that, too. In general, we are super aggressive with both amniotic membrane and steroid use in the hyperacute stage.”
Esen K. Akpek, M.D., associate professor of ophthalmology and director, Ocular Surface Diseases and Dry Eye Clinic, Wilmer Eye Institute, Johns Hopkins University, agrees that steroids can be helpful during the acute phase. But Akpek adds that in the long run, the steroids can end up causing a sepsis. For this reason, they try not to use steroids after the first week.
If you or a family member is suffering from SJS or TENS, contact Greg Jones today for a free consultation. I am an experienced SJS lawyer who will fight hard to help you.