1. Evaluation of Adjuvant Role of Amniotic Membrane Transplantation in Acute Stevens Johnson Syndrome With Medical Therapy in a Randomized Controlled Study First and presenting author: Namrata Sharma Co-authors: Thenarasun.S.A, Neena Khanna, Neelam Pushker, Manpreet Kaur, Rasik Vajpayee Affiliation: RP Centre, AIIMS, New Delhi, India None of the authors of this poster have any financial interests

2. Purpose To compare the adjuvant role of amniotic membrane transplantation (AMT) in ocular manifestations of acute Stevens-Johnson syndrome (SJS) with standard medical therapy (MT)

3. Methodology Type of study: Randomized prospective controlled clinical study Number of cases : 25 patients (50 eyes) of acute ocular SJS Group 1 : AMT with ST - 25 eyes ( bedside application) Group 2: MT alone - 25 eyes Inclusion criteria : Patients with acute ocular SJS presented within 2-3 weeks of manifesations, age>12 years, clinical diagnosis by dermatologist and with no microbial ocular infection

4. Parameters Evaluated Inducing agent Role of systemic steroids Best corrected visual acuity (BCVA) Ocular surface ( Shirmer’s test and Tear break up time- TBUT) Cornea-opacities, epithelial defect, keratinization,vasculariztion& conjunctivalization-Limbal stem cell deficiency) Conjunctiva- congestion and keratinization Lid abnormalities- ectropion,entropion, symblepharon, ankyloblepharon, trichiasis and metaplastic lashes Patient is examined at the time of presentation, daily post procedure for one week, and at the end of first, third and sixth months respectively

5. Outcome Measures Maintenance of BCVA Maintenance of ocular surface (shirmer’s test and TBUT) Prevention of chronic complications: cornea – opacities, keratinization, limbal stem cell deficiency Conjunctiva- congestion and keratinization Lid relared complications

6. Results Mean age was 31.69 ±16.6 years in AMT group and 27.92±12..4 years in MT group. There was female preponderance with M:F of 11:14. Majority of patients (72%) presented within first week of onset of symptoms. Conjunctival congestion was the most common initial presntation (96%). Out of 25 patients, 23 patients presented with symmetrical eye involvement. Mild category of presentation – 92% in AMT group and 84% in MT group. 14 patients were SJS, 3 were toxic epidermal necrolysis (TEN) and 8 were SJS-TEN complex. Most common inducing agent was anticonvusants (40%) of which phenytoin was frequent.

7. Results (Contd.) Mean BCVA at initial presentation was 0.0789±0.13 logMar units and 0.095±0.16 logMar units in AMT and MT groups respectively (p=0.384). Mean BCVA at the final follow up of 6 months was 0.068±0.10 logMar units and 0.522±0.529 logMar units in AMT group and MT group respectively, which was statistically significant (p=0.042). There was no significant difference between BCVA of patients who received low dose systemic steroids and those who did not (p=0.274).

8. Results (Contd.) Mean TBUT at initial presentation was 11.68±2.01 seconds and 12.64±1.8 seconds in AMT and MT groups respectively (p=0.14). Mean TBUT at the final follow up of 6 months was 9.92±4.1 seconds and 6.96±4.5 seconds in AMT group and MT group respectively, which was statistically significant (p=0.015). There was no significant difference between TBUT of patients who received low dose systemic steroids and those who did not (p=0.275).

9. Results (Contd.) Mean Shirmer’s test at initial presentation was 18.5±5.3 mm and 17.64±3.6 mm in AMT and MT groups respectively (p=0.136). Mean Shirmer’s test at the final follow up of 6 months was 15.44±6.1 mm and 8.96±5.5 mm in AMT group and MT group respectively, which was statistically significant (p< 0.001). There was no significant difference between Shirmer’s test of patients who received low dose systemic steroids and those who did not (p=0.0579).

10. Results (Contd.) There was significant corneal opacities (haze) in MT group i.e 44% (p=0.001) at the end of six months. Significant Corneal vascularization and conjunctivalization occurred only in MT group in 24% at 6 months follow up (p=0.03). Conjunctival congestion was seen in 44% of MT group as compared to 4% of AMT group (p=0.03). Lid related complications occurred only in MT group at 6 months as follows : symblepharon (16%), ectropion(8%), entropion(8%), trichiasis(24%) and metaplastic lashes(24%).

11. Conclusion Amniotic membrane transplantation along with standard medical treatment in acute ocular SJS helps in maintenance of best corrected visual acuity Mainatenance of good ocular surface – shirmer’s test and TBUT, thereby reducing the occurrence of dry eye

12. Conclusion Amniotic membrane transplantation along with standard medical treatment in acute ocular SJS also helps in preventing lid related complications- ectropion, entropion, symblepharon, trichiasis and metaplastic lashes Reducing the occurrence of corneal haze and limbal stem cell deficiency