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Plasmapheresis and autologous serum eye-drops in the treatment of acute ocular complications from toxic epidermal necrolysis (Lyell syndrome)

Pinna, Antonio <1963- > and Nuvoli, E. and Blasetti, Francesco and Posadinu, Maria Alma (2014) Plasmapheresis and autologous serum eye-drops in the treatment of acute ocular complications from toxic epidermal necrolysis (Lyell syndrome). Acta Ophthalmologica, Vol. 92 (s253). ISSN 1755-375X. eISSN 1755-3768. Article.

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DOI: 10.1111/j.1755-3768.2014.S056.x

Abstract

Purpose Toxic epidermal necrolysis (TEN) is a rare, life-threatening, drug-induced, mucocutaneous disease, which can affect the ocular surface. The purpose of this study was to evaluate the acute ocular complications from TEN and investigate on the efficacy of plasmapheresis and serum-eyedrops in the treatment of this condition.
Methods A retrospective chart review of all Burn Unit patients admitted from 2009-2013 identified 7 TEN patients (2 men, 5 women; mean age: 69.6±20.3 years). TEN was associated with allopurinol use in 4 patients, with gefitinib in 1, and with trimethoprim/sulphamethoxazole in 1. In the remaining patient, the causative agent was not identified. Acute bilateral ocular complications were observed in 5 patients; 3 showed mild ocular surface inflammation, whereas 2 had severe pseudomembranous conjunctivitis with corneal ulcers. All TEN patients were immediately treated with plasmapheresis.
Results In the 2-3 weeks after plasmapheresis, there was a marked improvement of the patients' general condition. In those with mild ocular surface inflammation, the use of preservative-free artificial tears and steroids was beneficial. In the 2 with pseudomembranous conjunctivitis and corneal ulcers, treatment with autologous serum eye-drops and preservative-free artificial tears was effective, resulting in corneal epithelium healing and mild conjunctival scarring.
Conclusion Not all TEN patients have ocular complications at onset. Plasmapheresis may be life-saving and contribute to reduce ocular surface inflammation. Autologous serum eye-drops prepared after plasmaferesis may be helpful in the management of the acute ocular complications caused by TEN.

Item Type:Article
ID Code:10318
Status:Published
Refereed:Yes
Uncontrolled Keywords:Toxic epidermal necrolysis (TEN), allopurinol use, trimethoprim/sulphamethoxazole, Lyell syndrome
Subjects:Area 06 - Scienze mediche > MED/30 Malattie apparato visivo
Divisions:001 Università di Sassari > 01-a Nuovi Dipartimenti dal 2012 > Scienze Chirurgiche, Microchirurgiche e Mediche
002 Altri enti e centri di ricerca del Nord Sardegna > Azienda ASL1, Sassari
Publisher:Blackwell / Wiley
ISSN:1755-375X
eISSN:1755-3768
Deposited On:17 Nov 2014 09:56

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