Toxic epidermal necrolysis (TEN) and Stevens-Johnson syndrome (SJS) are severe, rare skin reactions, usually to drugs, and are associated with widespread destruction of the epidermis. The 2 diseases are closely related: SJS is a limited form characterized by mucous membrane erosions and blisters on limited areas of the skin (<10% of the total body surface area), and TEN resembles superficial burns because of the confluence of blisters and erosions on more than 30% of the total body surface area. Overlapping cases are defined by an intermediate extent of the skin lesions.¹ The incidence of SJS and TEN is approximately 2 cases per million persons per year,² and the overall mortality rate is 20% to 25%.³ Ocular complications in SJS and TEN may occur acutely along with or after the onset of skin involvement. Severe ocular complications may even result in permanent visual loss due to corneal scarring or vascularization.^4-6 Little is currently known about the ocular symptoms of these diseases, particularly the long-term manifestations. Stevens-Johnson syndrome and TEN are viewed as a spectrum of systemic disease with increasing severity and mortality. A scoring system estimates severity and predicts mortality in patients with SJS or TEN.⁷ However, it remains unclear whether there are factors predictive of the frequency and severity of ocular complications, both acutely and over the long term. This study aimed to describe acute and late ocular manifestations and complications in SJS and TEN and to identify possible clinical predictors for the development of ocular complications.

Purpose.: Neurotrophic keratopathy is a degenerative disease of the corneal epithelium resulting from impaired corneal innervation, possibly leading to perforation. We aimed to assess the efficacy and tolerance of a new matrix therapy agent (RGTA, Cacicol20), mimicking heparan sulfates, for the management of neurotrophic keratopathy. Methods.: We carried out an uncontrolled, prospective, single-center clinical study on 11 patients (11 eyes) with severe corneal neurotrophic ulcers, despite the use of preservative-free artificial tears, for 15 days. Patients were treated with RGTA eye drops, instilled at a dosage of one drop in the morning, on alternate days. Evolution and follow-up during treatment were evaluated by slit-lamp examination, photography, fluorescein-dye testing, tests of corneal sensitivity, and best corrected visual acuity. The main outcome measures for each patient were healing of the corneal surface and best corrected visual acuity before and after RGTA therapy. Results.: Eight patients displayed complete corneal healing after a mean period of 8.7 weeks (range; 1 to 22 weeks). Mean ulcer area decreased significantly, from 11.12% to 6.37% (P = 0.048) in the first week, and to 1.56% (P = 0.005) at 1 month. Treatment failure was observed in three cases, requiring amniotic membrane transplantation in two patients and penetrating keratoplasty in one patient. At the end of the study, none of the patients displayed significant improvement in visual acuity. There were no systemic or local side effects of treatment. Conclusions.: RGTA seems to be a potentially useful, alternative, noninvasive therapeutic approach in neurotrophic keratopathy management. However, randomized studies are necessary.

Aims The aim of this study was to assess the efficacy and safety of pre-Descemet's membrane (DM) sutures associated with intracameral air injection for management of acute corneal hydrops associated with keratoconus. Methods We carried out a retrospective interventional study of seven consecutive cases. Three to seven pre-DM sutures with 10-0 nylon were applied perpendicularly to the tear as close as possible to DM, under general anaesthesia. An air bubble was injected into the anterior chamber at the end of each procedure. Results Corneal oedema began to decrease from day 1 after surgery in all our patients. Best-corrected visual acuity progressed from 2.13 to 1.65 logMar (p=0.031) 1 month after surgery, and from 2.13 to 0.84 logMar (p=0.016) 2 months after surgery. The mean corneal thickness measured by anterior segment optical coherence tomography decreased from 1472 µm (range 689–2770 µm) on day 0 to 909 µm (range 484–1640 µm) on day 1 (p=0.016), 716 µm (range 484–1380 µm) on day 15 (p=0.016) and 528 µm (range 404–618 µm) 1 month after surgery. Conclusions Our results suggest that intrastromal pre-DM sutures and intracameral air injection could promptly restore imperviousness of posterior stroma. This technique seems to be a safe and useful procedure to shorten acute corneal hydrops.