Grey line surgery for eyelid margin reconstruction in Stevens Johnson Syndrome

Session Details

Session Title: Training and Innovation

Session Date/Time: Tuesday 10/10/2017 | 16:30-18:00

Paper Time: 17:12

Venue: Room 4.4

First Author: : F.Murta UK

Co Author(s): :    J. Gomes                    

Abstract Details

Purpose:

Eyelid margin keratinisation is an important cause in the worsening and perpetuating of cornea damage in Stevens Johnson Syndrome (SJS). Current eyelid and ocular surface surgeries do not address the eyelid margin changes seen in SJS. These study had 3 purposes: 1. To describe a microsurgery technique to reconstruct severe graded keratinised eyelid margin in SJS patients using a partial thickness labial mucous graft; 2. To access the improvement of the ocular surface after this procedure; and 3. To monitor the survival of the partial thickness labial mucous graft during a 30 months follow-up.

Setting:

The study was developed at UNIFESP: Universidade Federal de Sao Paulo/ Brazil under the Ocular Surface and Oculoplastic departments. Ethical approval was obtained from the local health authority.

Methods:

Six SJS patients with severe keratinisation of the eyelid margin and conjunctiva grading 2 and 3, underwent “Grey line reconstructive surgery” using partial thickness labial mucous graft. The eyelid margin changes were graded using the classification of “The chronic changes of the mucocutaneous junction and the ocular surface on SJS” by the Department of Ophthalmology, Kyoto Prefectural University of Medicine. Post operative follow up including ocular surface fluorescent examination, record of patients’ report of symptom improvement and medical photographs performed on days 1 and 7, 1 month and every 4 months until 30 months post operative.

Results:

In all six cases operated upon, the partial thickness labial mucous graft had an excellent survival over the 30 months follow-up period, maintaining a well-defined junction of the graft and the anterior lid margin. The graft integrates easily to the tissue as a membrane without excessive elevation of the surface as seen in the case of full thickness oral mucous graft. The fluorescent examination of the ocular surface shows improvement of the chronic changes of the cornea and conjunctiva. All patients reported improvement of the comfort of ocular symptoms after surgery, which remained over the following 30 months.

Conclusions:

This microsurgical technique for eyelid margin reconstruction in keratinised eyelid margin in SJS using a partial thickness of the labial mucous graft, has been proven to be very effective in improving the status of the ocular surface. All patients experienced reductions in eye discomfort after surgery. Furthermore, the thin graft was shown to be durable, maintaining a stable condition over the 30 month follow-up period. Improving the eyelid margin reduces the continuous ocular damage caused by the continuous attrition of the keratinised tissue on the cornea.

Financial Disclosure:

NONE