Outcome of posterior lamellar replacement with oral mucous membrane graft in lid margin sequalae of Steven Johnson syndrome

Abstract

: to address common lid margin sequalae presented in steven Johnson syndrome and to assess the outcome of posterior lamellar replacement with oral mucous membrane graft. : This single center longitudinal study was conducted in Ispahani Islamia Eye Institute and Hospital. 56 diagnosed cases of Steven Johnson syndrome with lid margin sequalae during the period of July 2020 to June 2023 were included in the study. Patients with ocular cicatrizing pemphigoid and chemical burn were excluded from the study. Demographic profile, presenting lid margin sequalae, outcome of surgery and complication after intervention and its management were properly evaluated and recorded. : A total of 98 eyelids (upper and lower) in 56 patients were evaluated. The Mean age was 38.33 ± 15.22 years (range 6 – 70 years). 21 patients were male and 35 were female (male: female=1:1.66). 14 patients had unilateral defect and 42 patients have bilateral defect. Most common lid margin sequalae was lid margin keratinization (85.71%), distichiasis (62.5%), trichiasis (21.42%) and entropion (8.92%). All lid margin defect were successfully corrected by posterior lamellar replacement with oral mucous membrane graft. During 6 months post-operative follow up, significant symptomatic relief from epiphora, foreign body sensation, pain and photophobia were achieved in all patients. There was remarkable reduction of conjunctival inflammation (88.63%) and persistent corneal epithelial defect (71.42%). Mean visual acuity was significantly improved. Common complications of the surgery were misdirected lashes (7.14%), dislodgement of graft (2.04%%), and recurrent entropion (2.04%). All complication was successfully managed through appropriate second procedure.Posterior lamellar resection with an oral mucous membrane graft for modifying lid margin defects in Steven-Johnson syndrome shows promising results.