Journal of Clinical and Experimental Ophthalmology
Open Access
ISSN: 2155-9570
ISSN: 2155-9570
M Kataev
S.N. Fedorov â??Eye Microsurgery Complexâ?, Russia
Posters & Accepted Abstracts: J Clin Exp Ophthalmol
Lyell syndrome (toxic epidermal necrolysis (TEN)) and Stivens-Johnson syndrome (SJS, toxic allergic dermatitis) result in dramatic lesion of skin and mucous membranes. Almost all cases demonstrate ocular involvement. Conjunctival necrosis is followed by fornices shortening and eyelids deformity of various degrees. Our clinical group included 47 patients, 21 of them were children. Provocative agents were: Analgetics, sulfonamides, penicillin, unknown medicine, gamma-therapy, swimming in the river. Patients complained of irritation, itching, dryness or tearing, loss of vision. Clinical features included conjunctival scarring, mild to severe symblepharon, cicatrical entropion, metaplasy of conjunctival epithelium, trichiasis, tarsal plate deformity, lagophthalmos, leucoma. Conservative treatment provided limited efficacy. Previously in 6 eyes (6 patients) corneal perforation occurred. Surgery was aimed at the anatomical restoration of the eyelids and fornices, prevention of corneal damage with inverted eyelashes and dry epithelium, lining of the eyelidsâ?? back surface with moist membrane. Reconstruction of the fornices was perfomed with lip mucous grafts. Entropion and lagophthalmos were treated by mucous grafting to the posterior lamellar of the eyelids; compound split and full thickness grafts appeared to be more effective, than ordinary full thickness grafts. Transformed conjunctival epithelium was replaced with split mucous grafts. Cicatrically distorted eyelids required reconstruction of the tarsal plates and elimination of entropion. Electroepilation for trichiasis was necessary in 9 patients of 47. In 24 cases anatomical restoration was achieved by one step of surgery. 22 required from 2 to 4 steps. 1 patient was operated 9 times because of recurring lagophthalmos on dry eyes. In all patients normal anatomical form was regained, symblepharon, entropion and trichiasis cured. Residual lagophthalmos of 1-2 mm was persistent in 2 patients (3 eyes). 10 patients with severe preoperative xerosis regained slight moisture of the cornea, which improved their vision. One serious complication caused by lagophthalmos and xerosis was observed: Corneal perforation and endophthalmitis. Grafting of labial mucosa and tarsal reconstruction are main methods of surgery. Although plastic surgery in this group does not provide absolute phisiological normalization, it gives a significant relief in sufferings of the patients and enables their communication activity.
Email: mkataev@mail.ru