Long-Term Effect Of Scleral Contact Lenses On Mucous Membrane Graft In A Patient With Stevens-Johnson Syndrome: A 4-Years Follow Up

To report a case of Stevens-Johnson syndrome with severe chronic ocular sequelae who underwent mucous membrane grafting to replace the keratinised lid margins and was subsequently given scleral contact lenses for visual rehabilitation and symptomatic relief. Over a follow up period of 4 years, there was a significant decrease in corneal vascularisation, reduction in ocular surface inflammation and an additional benefit of ironing effect of scleral lenses on the mucous membrane graft which improved the cosmesis and comfort postoperatively in eyes with ocular surface disease.

Stevens-Johnson Syndrome(SJS) have chronic ocular sequelae including limbal stem cell deficiency, corneal vascularization and lid changes like lid margin keratinization causing corneal scarring. Management consist of ocular surface reconstruction by replacing keratinized lid margin with another mucosal surface harvested from lip or buccal mucosa to ensure adequate lid closure and achieve optimum scleral contact lens(SCL)fit. SCLs provide visual rehabilitation and protection to the ocular surface

A middle-aged female presented with a history of decreased vision and foreign body sensation due to severe dry eyes in both eyes for 20 years following her recovery from an acute phase of Stevens-Johnson Syndrome. On presentation, the best corrected visual acuity (BCVA) was 20/200 in both eyes. All four eyelids had lid margin keratinization which had led to severe lid wiper keratopathy, diffuse stromal scarring, and vascularization. She underwent oral mucous membrane graft (MMG) placement in all four lids. Postoperatively, MMG was noted to be thick and irregular. Patient was prescribed scleral lenses (SCL) (PROSE, Prosthetic replacement of ocular surface ecosystem, Boston, Massachusetts, USA). She was fitted with 18mm diameter lenses with a base curve of 7.9mm. The sagittal height was 4.85mm in the right eye and 4.55mm in the left eye with the spherical correction of -1.5DS and -2.75DS respectively. The central corneal clearance was 546um in the right eye and 702um in the left eye. With SCLs, her BCVA improved to 20/100 in the right eye and 20/125 in the left eye. Wearing schedule was 10-12hours/day with replacement of 0.9% normal saline every 4-5 hours. Subsequently, she underwent cataract surgery in both eyes. She was advised to restart the use of SCLs with which BCVA improved to 20/20 in the right eye and 20/30 in the left eye. Also, over a follow-up period of 4 years, her irregularly thick MMG had smoothened on the tarsal surface