Chie Sotozono1, Mayumi Ueta2, Eiji Nakatani3, Amane Kitami4, Hideaki Watanabe4, Hirohiko Sueki4, Masafumi Iijima4, Michiko Aihara5, Zenro Ikezawa5, Yukoh Aihara6, Yoko Kano7, Tetsuo Shiohara7, Mikiko Tohyama8, Yuji Shirakata8, Hideaki Kaneda3, Masanori Fukushima3, Shigeru Kinoshita2, Koji Hashimoto8. 1. Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan. Electronic address: csotozon@koto.kpu-m.ac.jp. 2. Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan. 3. Translational Research Informatics Center, Foundation for Biomedical Research and Innovation, Kobe, Japan. 4. Department of Dermatology, Showa University School of Medicine, Tokyo, Japan. 5. Department of Dermatology, Yokohama City University Medical Center, Yokohama, Japan. 6. Department of Pediatrics, Yokohama City University Medical Center, Yokohama, Japan. 7. Department of Dermatology, Kyorin University School of Medicine, Tokyo, Japan. 8. Department of Dermatology, Ehime University Graduate School of Medicine, Matsuyama, Japan.
Abstract
PURPOSE: To suggest an objective score for grading the acute ocular severity of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), and to determine predictive factors for severe acute ocular involvement such as ocular surface epithelial defect and/or pseudomembrane formation. DESIGN: Retrospective cohort study. METHODS: The medical records of SJS (n = 87) and TEN (n = 48) patients between 2005 and 2007 were reviewed. An acute ocular severity score was determined on a scale from 0 to 3 (none, mild, severe, and very severe) according to the existence of hyperemia, corneal or conjunctival epithelial defect, and pseudomembrane formation. The associations between the severe acute ocular involvement and factors such as patient age, exposed drugs, systemic severity, and the prevalence of ocular sequelae were examined. RESULTS: The number of cases with score grade 0, 1, 2, and 3 was 19 (21.8%), 31 (35.6%), 22 (25.3%), and 15 (17.2%) in 87 SJS cases and 12 (25.0%), 11 (22.9%), 17 (35.4%), and 8 (16.7%) in 48 TEN cases. Multivariate logistic regression analysis revealed that patient age (odds ratio [OR], 0.98; 95% confidence interval [CI], 0.96-0.99; P = .007) and nonsteroidal anti-inflammatory drugs NSAIDs or cold remedies (OR, 2.58; 95% CI, 1.26-5.29; P = .010) were predictive factors for severe acute ocular involvement. The prevalence of visual disturbance and eye dryness increased according to the increase of acute ocular severity (P = .001 and P = .007 in SJS; P = .007 and P = .014 in TEN, respectively). CONCLUSIONS: At the onset of SJS/TEN, strict attention should be paid to ocular involvement in young patients and in patients exposed to NSAIDs or cold remedies.
PURPOSE: To suggest an objective score for grading the acute ocular severity of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), and to determine predictive factors for severe acute ocular involvement such as ocular surface epithelial defect and/or pseudomembrane formation. DESIGN: Retrospective cohort study. METHODS: The medical records of SJS (n = 87) and TEN (n = 48) patients between 2005 and 2007 were reviewed. An acute ocular severity score was determined on a scale from 0 to 3 (none, mild, severe, and very severe) according to the existence of hyperemia, corneal or conjunctival epithelial defect, and pseudomembrane formation. The associations between the severe acute ocular involvement and factors such as patient age, exposed drugs, systemic severity, and the prevalence of ocular sequelae were examined. RESULTS: The number of cases with score grade 0, 1, 2, and 3 was 19 (21.8%), 31 (35.6%), 22 (25.3%), and 15 (17.2%) in 87 SJS cases and 12 (25.0%), 11 (22.9%), 17 (35.4%), and 8 (16.7%) in 48 TEN cases. Multivariate logistic regression analysis revealed that patient age (odds ratio [OR], 0.98; 95% confidence interval [CI], 0.96-0.99; P = .007) and nonsteroidal anti-inflammatory drugs NSAIDs or cold remedies (OR, 2.58; 95% CI, 1.26-5.29; P = .010) were predictive factors for severe acute ocular involvement. The prevalence of visual disturbance and eye dryness increased according to the increase of acute ocular severity (P = .001 and P = .007 in SJS; P = .007 and P = .014 in TEN, respectively). CONCLUSIONS: At the onset of SJS/TEN, strict attention should be paid to ocular involvement in young patients and in patients exposed to NSAIDs or cold remedies.
Authors: Tais H Wakamatsu; Mayumi Ueta; Katsushi Tokunaga; Yukinori Okada; Renata R Loureiro; Karita A Costa; Juliana Maria F Sallum; José Arthur Milhomens; Chikara Inoue; Chie Sotozono; José Álvaro P Gomes; Shigeru Kinoshita Journal: JAMA Ophthalmol Date: 2017-04-01 Impact factor: 7.389