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Umbilical cord blood serum for the treatment of ocular involvement in toxic epidermal necrolysis

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First Author: M.Berges Marti SPAIN

Co Author(s):    E. Kirkegaard Biosca   B. Azarfane   S. Martin Nalda   L. Bisbe López   J. Puig Galy        

Abstract Details

Purpose:

Toxic epidermal necrolysis (NET) is an immune-mediated mucocutaneous disease that can present ocular involvement. Early treatment with amniotic membrane transplantation (AMT) associated with topical treatment in severe cases has demonstrated to promote epithelization, help prevent adhesion of injured surfaces, decrease inflammation and resultant chronic sequelae. Umbilical cord blood serum (UCBS) has been used to effectively treat ocular surface diseases compared to other blood derivates such as autologous serum. Our purpose is to report three cases of management of NET with ocular involvement with UCBS associated to habitual treatment.

Setting:

Vall d’Hebron University Hospital Burn Unit and Ophthalmology department, Barcelona.

Methods:

We present three cases of patients affected with NET with several ocular involvement. Two cases showed pseudomembranes and eyelid margin involvement in both eyes and in the other case corneal epithelial defects were noted in both eyes. Early treatment with topical corticosteroids, antibiotics and lubrication was initiated after removing pseudomembranes with cotton tipped applicators. AMT with perforated conformer was promptly performed. In addition, treatment with UCBS was started every 1 or 2 hours. When amniotic membrane was removed scleral lenses were used to protect and help healing ocular surface and treatment with tacrolimus ointment was added in two cases.

Results:

During the follow up healing of corneal epithelial defects was observed in all cases. Minimal corneal haze was observed in one case, but corneal transparency was maintained in the other cases. Corneal sensitivity was conserved, and an improvement of symptoms was noted in all cases. In the cases that presented pseudomembranes in the acute phase, a moderate forniceal and tarsal conjunctival fibrosis was noted during the chronic phase.

Conclusions:

Umbilical cord blood serum has been used to treat successfully ocular surface disorders such as persistent and neurotrophic epithelial defects, dry eye, graft versus host disease and chemical keratitis but it has not been reported its use already in NET. We have observed good results in NET cases with severe ocular involvement getting fast and high epithelial healing rate, high percentage of corneal transparency and greater improvement of symptoms and preservation of cornea sensitivity. UCBS can be used in addition with habitual treatment in cases of ocular involvement in NET to help preventing chronic ocular complications.

Financial Disclosure:

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