DR.JITENDER JINAGAL

, Dr. ARUN KUMAR JAIN, DR. AMIT GUPTA

Abstract

A 38 years old, female presented with low vision, inability to open and severe dryness in both eyes. she was a diagnosed case of chronic ocular Steven Johnson syndrome. Visual acuity was hand motion and 6/36. Ocular surface examination showed severe lid margin keratinization, distichiasis, severe conjunctival congestion. Right eye was in stage of corneal melt with diffuse thinning over 8×9 mm of cornea and impending perforation. Left eye was having persistent epithelial defect. As prognosis of full thickness graft survival in SJS patient are bleak, we planned to rescue the melting cornea with a novel idea. Under sub tenons anesthesia, we cleaned the area of impending perforation and placed SMILE lenticule over it with fibrin glue, followed by “figure of 8 – over pass – criss cross corneal suturing covering the lenticule. Amniotic membrane graft was secured followed by a conjunctival pedicle graft in nasal paracentral cornea to enhance healing. Post op ASOCT showed successful outcomes.