Amniotic membrane transplantation techniques in acute ocular Stevens-Johnson syndrome and toxic epidermal necrolysis:...

Ocular involvement in Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TENS) is common and can result in severe acute inflammation and long-term complications. Early intervention with amniotic membrane transplantation (AMT) is essential to preserve long term ocular surface integrity and function. This review aimed to evaluate and compare the different surgical techniques to AMT in the acute phase of SJS/TENS, covering sutured, glued, and sutureless/glueless approaches. A systematic search of PubMed, MEDLINE, Embase, Scopus, Cochrane, Google Scholar, and reference lists identified 630 articles, with 27 studies meeting inclusion criteria. Sutured AMT remains the most commonly used method due to its ability to provide comprehensive ocular surface coverage, however is time-consuming and often requires general anaesthesia. Glued AMT, using fibrin or cyanoacrylate adhesive, offers a faster, less invasive alternative suitable for bedside application, though evidence in SJS/TENS is limited. Sutureless/glueless options such as the Prokera® enable rapid deployment and patient comfort but do not provide full ocular surface protection and should only be usedas adjuncts. Hybrid glued approaches with limited suturing may be appropriate for extensive coverage with bedside application. Overall, the choice of technique depends on the extent of ocular involvement, patient stability, and available resources. Further studies are needed to directly compare outcomes across different AMT approaches in acute ocular SJS/TENS.