Ocular outcomes of amniotic membrane transplantation in acute and chronic Stevens-Johnson syndrome and toxic epidermal necrolysis: a systematic review.

PURPOSE: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) can cause devastating systemic injury and ocular surface destruction. This systematic review aims to synthesize current clinical evidence on ocular outcomes following amniotic membrane transplantation (AMT) in patients affected by SJS/TEN in the acute and chronic phases of disease and to provide clarity on the efficacy of standard and novel surgical techniques. METHODS: We performed a systematic literature search in PubMed, Embase, Cochrane, Scopus, and Web of Science using a standardized search strategy. Screening, data extraction, and risk of bias assessments were performed by two independent reviewers using recommendations from the Cochrane Handbook. Studies were categorized based on timing of AMT and surgical technique, and ocular outcomes were recorded with a narrative synthesis. RESULTS: A total of 54 included studies supported the use of AMT in ocular SJS/TEN. Acute AMT, ideally within 2 weeks of symptom onset, resulted in a best-corrected visual acuity (BCVA) of 20/50 or better in most patients and low rates of long-term ocular sequelae. AMT covering the entire ocular surface was associated with better reported outcomes than Prokera in the included studies, although direct comparative evidence was limited. Novel sutureless surgical techniques using symblepharon rings and glue appeared to reduce surgical risks while maintaining comparable reported patient outcomes. AMT applied in the chronic phase was associated with some symptomatic improvement. CONCLUSIONS: The available evidence suggests that standard and sutureless AMT should be considered in the ophthalmic management of acute phase SJS/TEN patients to help prevent chronic ocular sequelae. Chronic phase AMT may have optimal clinical utility when used in conjunction with other grafts. However, these findings are based largely on observational studies with heterogenous methodologies, and higher-quality comparative studies are needed to confirm these findings.