Objective: To report successful management of acute stage toxic epidermal necrolysis (TEN) by amniotic membrane transplantation. Design: Interventional case report. Method/Intervention: A 6-year-old boy who had convul...Objective: To report successful management of acute stage toxic epidermal necrolysis (TEN) by amniotic membrane transplantation. Design: Interventional case report. Method/Intervention: A 6-year-old boy who had convulsions and fever due to encephalitis was treated by oral phenobarbital. Two weeks later, he developed a high fever and skin rashes involving >40%of the body, with a positive Nikolsky sign and oral blisters. Examination under general anesthesia performed 5 days after the onset of eye symptoms showed severe inflammation and ulceration on the lid margin and the tarsal conjunctiva in both eyes, a total corneal epithelial defect in the right eye, and a geographical corneal epithelial defect in the left eye. Amniotic membrane was transplanted in both eyes as a patch to cover the entire ocular surface, including upper and lower lid margins. Results: Fourteen days after amniotic membrane transplantation, complete corneal and conjunctival epithelialization was observed in the left eye. However, a second amniotic membrane transplantation was performed in the right eye, which still had a total corneal and conjunctival epithelial defect, and resulted in complete epithelialization 14 days later. Corrected visual acuity improved to 20/16 without any superficial punctate keratitis in both eyes 6 months postoperatively. Minimal symblepharon and peripheral scarring were observed only in the right eye. Conclusions: Amniotic membrane transplantation performed at the acute phase of TEN is highly effective not only in reducing inflammation and preventing scarring in the conjunctival surface, but also in restoring corneal epithelial integrity in eyes with both corneal and conjunctival ulceration. As a result, in this case it prevented sight-threatening cicatricial complications at the chronic stage.展开更多
Objective: To report in vivo corneal confocal microscopic findings of patients with central cloudy dystrophy of Franc.ois. Methods: Two unrelated patients, a 78- year- old man and a 75- year- old woman, with central c...Objective: To report in vivo corneal confocal microscopic findings of patients with central cloudy dystrophy of Franc.ois. Methods: Two unrelated patients, a 78- year- old man and a 75- year- old woman, with central cloudy dystrophy of Franc.ois were examined using routine slitlamp biomicroscopy and confocal microscopy. Results: In both cases, slitlamp biomicroscopy showed bilateral polygonal opacities separated by clear spaces. The corneal opacities were most prominent centrally and were located in the deeper stromal layer immediately anterior to the Descemet membrane. By confocal microscopy, normal superficial and basal epithelial layers, midstromal layers, and endothelial layers were noted in both cases. However, small highly refractile granules and deposits were observed in the anterior stromal layer in both cases. Also, multiple dark striae among the extracellular matrix with increased intensities were observed in the posterior stroma adjacent to the corneal endothelial layer in both cases. Conclusions: Abnormal stromal deposits and multiple dark striae were observed in central cloudy dystrophy of Franc.ois using in vivo corneal confocal microscopy. Use, of confocal microscopy to investigate these abnormal stromal opacities may be helpful in differentiating various corneal stromal pathologic features.展开更多
文摘Objective: To report successful management of acute stage toxic epidermal necrolysis (TEN) by amniotic membrane transplantation. Design: Interventional case report. Method/Intervention: A 6-year-old boy who had convulsions and fever due to encephalitis was treated by oral phenobarbital. Two weeks later, he developed a high fever and skin rashes involving >40%of the body, with a positive Nikolsky sign and oral blisters. Examination under general anesthesia performed 5 days after the onset of eye symptoms showed severe inflammation and ulceration on the lid margin and the tarsal conjunctiva in both eyes, a total corneal epithelial defect in the right eye, and a geographical corneal epithelial defect in the left eye. Amniotic membrane was transplanted in both eyes as a patch to cover the entire ocular surface, including upper and lower lid margins. Results: Fourteen days after amniotic membrane transplantation, complete corneal and conjunctival epithelialization was observed in the left eye. However, a second amniotic membrane transplantation was performed in the right eye, which still had a total corneal and conjunctival epithelial defect, and resulted in complete epithelialization 14 days later. Corrected visual acuity improved to 20/16 without any superficial punctate keratitis in both eyes 6 months postoperatively. Minimal symblepharon and peripheral scarring were observed only in the right eye. Conclusions: Amniotic membrane transplantation performed at the acute phase of TEN is highly effective not only in reducing inflammation and preventing scarring in the conjunctival surface, but also in restoring corneal epithelial integrity in eyes with both corneal and conjunctival ulceration. As a result, in this case it prevented sight-threatening cicatricial complications at the chronic stage.
文摘Objective: To report in vivo corneal confocal microscopic findings of patients with central cloudy dystrophy of Franc.ois. Methods: Two unrelated patients, a 78- year- old man and a 75- year- old woman, with central cloudy dystrophy of Franc.ois were examined using routine slitlamp biomicroscopy and confocal microscopy. Results: In both cases, slitlamp biomicroscopy showed bilateral polygonal opacities separated by clear spaces. The corneal opacities were most prominent centrally and were located in the deeper stromal layer immediately anterior to the Descemet membrane. By confocal microscopy, normal superficial and basal epithelial layers, midstromal layers, and endothelial layers were noted in both cases. However, small highly refractile granules and deposits were observed in the anterior stromal layer in both cases. Also, multiple dark striae among the extracellular matrix with increased intensities were observed in the posterior stroma adjacent to the corneal endothelial layer in both cases. Conclusions: Abnormal stromal deposits and multiple dark striae were observed in central cloudy dystrophy of Franc.ois using in vivo corneal confocal microscopy. Use, of confocal microscopy to investigate these abnormal stromal opacities may be helpful in differentiating various corneal stromal pathologic features.
