The amniotic membrane in ophthalmology

The members of the Management and Therapy Subcommittee assessed current dry eye therapies. Each member wrote a succinct evidence-based review on an assigned aspect of the topic, and the final report was written after review by and with consensus of all subcommittee members and the entire Dry Eye WorkShop membership. In addition to its own review of the literature, the Subcommittee reviewed the Dry Eye Preferred Practice Patterns of the American Academy of Ophthalmology and the International Task Force (ITF) Delphi Panel on Dry Eye. The Subcommittee favored the approach taken by the ITF, whose recommended treatments were based on level of disease severity. The recommendations of the Subcommittee are based on a modification of the ITF severity grading scheme, and suggested treatments were chosen from a menu of therapies for which evidence of therapeutic effect had been presented.

Management and therapy of dry eye disease: Report of the management and therapy subcommittee of the international Dry Eye WorkShop (2007)

https://www.ukr.de/imperia/md/content/kliniken-institute/haematologie-onkologie/gvhd/deutsch/couriel-2006-bbmt.pdf

Ancillary Therapy and Supportive Care of Chronic Graft-versus-Host Disease: National Institutes of Health Consensus Development Project on Criteria for Clinical Trials in Chronic Graft-versus-Host Disease: V. Ancillary Therapy and Supportive Care Working Group Report

Objective To perform a comprehensive review of Stevens-Johnson syndrome and toxic epidermal necrolysis. Data Sources A MEDLINE search was performed for the years 1975 to 2003 using the keywords Stevens-Johnson syndrome and toxic epidermal necrolysis to identify relevant articles published in English in peer-reviewed journals. Study Selection All clinical studies that reported on 4 or more patients, review articles, and experimental studies that concerned disease mechanisms were selected and further analyzed. Clinical reports that included fewer than 4 patients were selected only if they were believed to carry a significant message about disease mechanism or therapy. Results Stevens-Johnson syndrome and toxic epidermal necrolysis seem to be variants of the same disease with differing severities. A widely accepted consensus regarding diagnostic criteria and therapy does not exist at present. Despite the recent experimental studies, the pathogenic mechanisms of these diseases remain unknown. Although progress in survival through early hospitalization in specialized burn units has been made, the prevalence of life-long disability from the ocular morbidity of Stevens-Johnson syndrome and toxic epidermal necrolysis has remained unchanged for the past 35 years. Further progress depends on modification of the acute phase of the disease rather than continuation of supportive care. The available published evidence indicates that a principal problem in the pathogenesis is immunologic and that immunomodulatory intervention with short-term, high-dose intravenous steroids or intravenous immunoglobulin holds the most promise for effective change in survival and long-term morbidity. Conclusions The results of this review call for a widely accepted consensus on diagnostic criteria for Stevens-Johnson and toxic epidermal necrolysis and multicenter collaboration in experimental studies and clinical trials that investigate disease mechanisms and novel therapeutic interventions, respectively.

Stevens-Johnson syndrome and toxic epidermal necrolysis: a review of the literature.

Gas-permeable scleral contact lens therapy in ocular surface disease.

Treatment of persistent corneal epithelial defect with extended wear of a fluid-ventilated gas-permeable scleral contact lens

Fluid-ventilated, gas-permeable scleral lenses are a valuable front-line tool in the management of severe ocular surface disease. In addition to enhancing vision, they have the potential to reduce greatly the disabling ocular pain and photophobia associated with SJS, TEN, and ocular cicatricial pemphigoid. They are also useful in healing some PEDs that are refractory to all other treatment strategies and in reducing PED recurrence in stem cell-deficient and neurotrophic corneas. The therapeutic benefits of these lenses are provided by the oxygenated aqueous environment they create over the corneal epithelium. The oxygenated precorneal fluid compartment that is maintained at neutral pressure protects the epithelial surface from the desiccating effects of exposure to air and the friction generated by blinking and avoids the shearing forces generated during the blink-induced movement of soft lenses.

https://www.ophthalmology.theclinics.com/article/S0896-1549(02)00067-6/pdf

The Boston Scleral Lens in the management of severe ocular surface disease

Background Scleral contact lenses provide unique therapeutic and vision rehabilitative properties that overcome the therapeutic gaps encountered with conventional contact lens therapies. Case reports Four case reports are presented in which serious visual impairment was remediated with the application of scleral contact lenses: kerataconus, Terriens marginal degeneration, penetrating keratoplasty from Fuchs' dystrophy, and Stevens-Johnson syndrome. Conclusion The availability of new and diverse materials--in particular, the use of highly oxygen-permeable materials for scleral contact lenses--has allowed reevaluation of the clinical role of scleral lenses in the management of irregular corneal surface disorders and ocular surface disease.

Janis Cotter

Papers

Gas-permeable scleral contact lens therapy in ocular surface disease.

Treatment of persistent corneal epithelial defect with extended wear of a fluid-ventilated gas-permeable scleral contact lens

The Boston Scleral Lens in the management of severe ocular surface disease

Scleral contact lenses

Surgical reconstruction of the ocular surface in advanced ocular cicatricial pemphigoid and Stevens-Johnson syndrome.