Thursday, April 26, 2012

Fetal Membrane Transplantation Helps Prevent Blindness in Patients with Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis

Loyola Researchers Report Findings in the Journal Cornea

MAYWOOD, Ill. -- Transplanting tissue from newborn fetal membranes prevents blindness in patients with a devastating disease called Stevens-Johnson Syndrome, a Loyola University Medical Center study has found.

The study by senior author Charles Bouchard, MD, and colleagues is published online ahead of print in the journal Cornea.

Stevens-Johnson Syndrome (SJS) is a disorder in which skin and mucous membranes, including the eye surface, react severely to a medication or infection. SJS causes painful skin blisters, and as the disease progresses, the skin sloughs off as if the patient had been burned. A more severe form of the disease, involving more than 30 percent of the body surface, is called toxic epidermal necrolysis (TEN).

Between 50 percent and 81 percent of SJS/TEN patients experience eye problems, ranging from mild dry eye to severe scarring that can cause blindness.
Loyola researchers studied a relatively new eye treatment for SJS/TEN patients called amniotic membrane transplantation. Amniotic membrane is part of the fetal membranes that surround and protect the baby in the womb, and have natural therapeutic properties. When placed on the eye, amniotic membrane can help aid healing, decrease inflammation and minimize scarring. (Amniotic membrane is donated by a consenting mother following the birth of her baby.)

SJS/TEN has an earlier acute stage and a later chronic stage. Previous studies have found that amniotic membrane transplantation is effective in the chronic stage. The Loyola case-control study is one of the largest studies to examine the effect of amniotic membrane transplantation in the early, acute stage. The first case reported in a medical journal was done by a Loyola ophthalmologist, Dr. Thomas John.

Researchers examined the records of 128 SJS/TEN patients admitted to the Loyola University Medical Center Burn Intensive Care Unit from 1998 to 2010. Some patients died and in other cases there wasn’t sufficient follow-up reporting. Among the remaining patients, researchers compared recent patients with mild, moderate and severe disease who received amniotic membrane transplantation with similar patients who did not receive this treatment because it was not available at the time.

Thirteen of the recent patients underwent amniotic membrane transplantation on a total of 25 eyes during the early stage of the disease, and 17 patients (33 eyes) received standard medical management but no transplantation. After three months, only 4.3 percent of the eyes treated with amniotic membrane transplantation were legally blind (vision worse than 20/200 when corrected). By comparison, 35 percent of the eyes treated with medical management alone were legally blind.

Researchers wrote: "Our results support the use of early amniotic membrane transplantation, within the first three to five days, over the entire ocular surface . . . If the amniotic membrane is placed more than one week after the onset of the disease, the beneficial effects may be reduced."

Researchers are now examining the levels of a variety of inflammatory mediators in the skin, blood, eye and mouth in patients with SJS/TEN to better understand the cause of this devastating disease and to develop better treatments.

Drs. Charles Bouchard and Amy Lin, MD, performed the amniotic membrane transplants in the study. Bouchard is chairman and Lin is an assistant professor in the Department of Ophthalmology of Loyola University Chicago Stritch School of Medicine.

Co-authors of the study, all in Loyola's Department of Ophthalmology, are Maylon Hsu, MD, (first author), Anupam Jayaram, MD, and Ruth Verner, BS.

About Loyola University Health System

Loyola University Health System (LUHS) is part of Trinity Health. Based in the western suburbs of Chicago, LUHS is a quaternary care system with a 61-acre main medical center campus, the 36-acre Gottlieb Memorial Hospital campus and more than 30 primary and specialty care facilities in Cook, Will and DuPage counties. Loyola University Medical Center’s campus is conveniently located in Maywood, 13 miles west of Chicago’s Loop and 8 miles east of Oak Brook, Ill. At the heart of the medical center campus is a 559-licensed-bed hospital that houses a Level 1 Trauma Center, a Burn Center and the Ronald McDonald® Children's Hospital of Loyola University Medical Center. Also on campus are the Cardinal Bernardin Cancer Center, Loyola Outpatient Center, Center for Heart & Vascular Medicine and Loyola Oral Health Center as well as Loyola University Chicago Stritch School of Medicine, Loyola University Chicago Marcella Niehoff School of Nursing and the Loyola Center for Fitness. Loyola's Gottlieb campus in Melrose Park includes the 255-licensed-bed community hospital, the Professional Office Building housing 150 private practice clinics, the Adult Day Care, the Gottlieb Center for Fitness, Loyola Center for Metabolic Surgery and Bariatric Care and the Loyola Cancer Care & Research at the Marjorie G. Weinberg Cancer Center at Melrose Park.

Trinity Health is a national Catholic health system with an enduring legacy and a steadfast mission to be a transforming and healing presence within the communities we serve. Trinity is committed to being a people-centered health care system that enables better health, better care and lower costs. Trinity Health has 88 hospitals and hundreds of continuing care facilities, home care agencies and outpatient centers in 21 states and 119,000 employees.