Toxic epidermal necrolysis (TEN) is a rare, life-threatening, drug-induced, mucocutaneous disease, which can severely affect the ocular surface. The purpose of this study was to investigate the efficacy of plasmapheresis, human IV immunoglobulins (IVIg), and autologous serum (AS) eyedrops in the treatment of the severe acute ocular complications of TEN.
A retrospective chart review of all patients admitted to the Burn Unit, Azienda Ospedaliero-Universitaria-Sassari, Sassari, Italy, from 2009 to 2015, identified 9 patients (2 men, 7 women; mean age 63.8 ± 24.7 years) with TEN. Bilateral, acute ocular surface complications were observed in 7 (78%) patients; 3 showed catarrhal conjunctivitis, whereas 4 had severe pseudomembranous conjunctivitis and corneal ulcers.
All patients with TEN were immediately treated with plasmapheresis and human IVIg, which produced a marked improvement in the patients’ general condition. In the 3 with catarrhal conjunctivitis, preservative-free artificial tears and topical antibiotics were beneficial. In the 4 with severe pseudomembranous conjunctivitis and corneal ulcers, treatment with AS eyedrops resulted in corneal and conjunctival epithelium healing over 3-6 weeks. After a minimum follow-up of at least 12 months, there were minimal/mild residual signs and symptoms of dry eye.
Plasmapheresis and IVIg may be life-saving and contribute to reduce ocular surface inflammation in TEN. Autologous serum eyedrops, prepared after plasmapheresis completion and IVIg infusion, may be helpful in the management of the severe acute ocular complications of TEN.
Eur J Ophthalmol 2017; 27(6): 658 - 663
Article Type: ORIGINAL RESEARCH ARTICLE
AuthorsAntonio Pinna, Eleonora Nuvoli, Francesco Blasetti, Maria Alma Posadinu, Francesco Boscia
- • Accepted on 20/02/2017
- • Available online on 21/03/2017
- • Published in print on 08/11/2017
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- Pinna, Antonio [PubMed] [Google Scholar] 1, 2, * Corresponding Author (email@example.com)
- Nuvoli, Eleonora [PubMed] [Google Scholar] 1
- Blasetti, Francesco [PubMed] [Google Scholar] 1
- Posadinu, Maria Alma [PubMed] [Google Scholar] 3
- Boscia, Francesco [PubMed] [Google Scholar] 1, 2
Section of Ophthalmology, Department of Surgical, Microsurgical, and Medical Sciences, University of Sassari, Sassari - Italy
Unità Operativa di Oculistica, Azienda Ospedaliero-Universitaria-Sassari, Sassari - Italy
Centro Ustioni, Azienda Ospedaliero-Universitaria-Sassari, Sassari - Italy