The risk-benefit ratio of doing AMGin a case of Ocular affection in Steven Johnson syndrome and the associated risks of general anaesthesia?

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Jayesh Vazirani

The benefits of amniotic membrane application in acute SJS are increasingly being accepted. In cases with extensive epithelial sloughing over the cornea, conjunctiva and eyelid margins, AMG is strongly recommended.

If AMG can be performed in a sterile, controlled environment such as the operating room under general anesthesia, it is obviously preferable. This decision is best taken in consultation with the treating intensive care specialist and anesthesiologist. Quite often this is possible with minimal risk.

In cases where shifting the patient to the OR or giving GA is deemed too risky, AMG can be done even at the bedside taking aseptic precautions.

As with all decision making in medicine, risks and benefits ought to be thoroughly discussed with the primary physician as well as the caregivers of the patient.

Regards,

Jayesh

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Sushobhan Dasgupta

Lot of thanx to u Sir for your opinion. I have got excellent outcome with few such acute cases of SJS ( mostly because of anticonvulsants), in my experience, which I didn't get in chronic/late cases. But, many a times I have seen anaesthetist would like to defer the case either because of high INR or deranged coagulation profile or fear of tracheal bleed during intubation, which hinders the ocular prognosis. Can u please share your experience in doing bedside AMG procedure (as I have no such experience), particularly in children who doesn't allow to even touch their eyelids during acute stage. Thanking u again. Sincere regards- S. Dasgupta.