During the first few days of my rotation in the emergency room, I had encountered a patient that seemed to be having a drug reaction to Lamictal. She had started the medication two weeks prior to presentation, and even though it was hard to believe that her rash was related to Steven Johnson, she was admitted because of that very reason. There are studies that show an increased rate of SJS and TEN’s in the pediatric population that is using Lamictal, but not in the adult population. With that being said, the patient was told to discontinue the medication right away, and was admitted with close observation until the rash went away. She was safely discharged three days later. This article relevant to my patient in that is purposes a new method of solving ocular complications secondary to Steven Johnson Syndrome. According to this article, 70-80% of all Steven Johnson Syndrome patients present with ocular involvement, and are traditionally treated with membrane transplantation, but this article challenged the norm to see if there would be a better outcome if amniotic membrane transplantation would have a greater success rate when compared to the traditional transplantation. This study was done back in 2015, in India as a Prospective Randomized Control Trial, and it involved a total of 25 people, which means 50 eyes. About half of the population was assigned to the amniotic membrane transplantation. The amniotic membrane was obtained with consent of the donor, was sterilized and prepped for the transplantation. The participants were separated into patient presenting early on when symptoms first appeared, within the first 4 days, to patients presenting within two weeks of the onset of symptoms. The main measure of outcome that was focused on was visual acuity and if there was stability in the ocular surface post transplantation. In general, it was noted that the group with the amniotic membrane transplantation had more statistical and clinical success, achieving higher levels of visual acuity and more stable ocular surfaces than the traditional membrane transplantation. Limitations of this article include that it was done in India, which means that it could have many barriers to apply to the general population in the United States, and also that there was a very small sample size. Even though this is great step forward, I believe much more research needs to be on in this area to consider amniotic membrane transplantation for SJS ocular involvement as a new norm treatment.
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