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Placement of ProKera in the Management of Ocular Manifestations of Acute Stevens-Johnson Syndrome in an Outpatient

Kolomeyer, Anton M. M.D., Ph.D.; Do, Brian K. M.D.; Tu, Yufei M.D.; Chu, David S. M.D.

doi: 10.1097/ICL.0b013e318255124f
Case Report

Purpose: To report the clinical use of ProKera (Bio-Tissue, Inc., Miami, FL) under topical anesthesia in an outpatient for the management of ocular manifestations of acute Stevens-Johnson syndrome (SJS).

Methods: Interventional case report.

Results: A 19-year-old woman developed acute SJS with ocular involvement after ingestion of oral antibiotics. Slit-lamp examination performed 2 weeks later showed severe inflammation and areas of ulceration along all 4 lids and complete, bilateral sloughing of bulbar and palpebral conjunctivae, including the limbus. ProKera was placed under topical anesthesia without sedation in both eyes instead of an amniotic membrane due to excess risk of general anesthesia. Three weeks after placement, slit-lamp examination showed complete re-epithelialization of both corneas and conjunctivae, with only trace conjunctival injection and minor limbal epithelial irregularities. Three months postprocedure, there were no signs of clinically significant scarring, and the visual acuity (VA) was 20/20 bilaterally. Fourteen months postprocedure, VA remained stable, and the patient did not have dry eye, photophobia, clinically significant scarring, or symblepharon.

Conclusions: ProKera placement performed under topical anesthesia may be appropriate for the treatment of ocular surface manifestations of acute SJS particularly in those patients followed in an outpatient setting with milder forms of disease and/or with contraindications to general anesthesia.

Institute of Ophthalmology and Visual Science (A.M.K., B.K.D., Y.T., D.S.C), New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, NJ; Metropolitan Eye Research and Surgery Institute (D.S.C.), Palisades Park, NJ.

Address correspondence and reprint requests to David S. Chu, M.D., The Institute of Ophthalmology and Visual Science, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Doctors Office Center, Suite 6100, PO Box 1709, Newark, NJ 07101-1709; e-mail: chuda@umdnj.edu

Supported in part by an unrestricted grant from Research to Prevent Blindness and the Lions Eye Research Foundation of New Jersey.

This study conforms to the Health Insurance Portability and Accountability Act (HIPAA) and adheres to the Declaration of Helsinki and all applicable state and federal laws.

The authors have no funding or conflicts of interest to disclose.

Accepted March 10, 2012

© 2013 Contact Lens Association of Ophthalmologists, Inc.