Swapna S Shanbhag1, Ramy Rashad2, James Chodosh3, Hajirah N Saeed4. 1. Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts, USA; Tej Kohli Cornea Institute, L.V. Prasad Eye Institute, Hyderabad, India. 2. Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts, USA; Tufts University School of Medicine, Boston, Massachusetts, USA. 3. Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts, USA. 4. Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts, USA. Electronic address: Hajirah_Saeed@meei.harvard.edu.
Abstract
PURPOSE: To describe the long-term effect of a treatment protocol for ocular involvement in acute Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN), including focused ocular examination and pathology-appropriate use of lubrication, topical corticosteroids, topical antibiotics, and amniotic membrane transplantation (AMT). DESIGN: Retrospective, comparative case series. METHODS: A total of 48 patients (96 eyes) were included in this study. Nine of 48 patients (18 eyes) had acute SJS/TEN from 2000 to 2007 and did not receive protocol care (Group I). Thirty-nine of 48 patients (78 eyes) had acute SJS/TEN from 2008 to 2017 and received protocol care (Group II). The main outcome measures were best-corrected visual acuity (BCVA) at final follow-up visit and incidence of complications in the chronic phase. RESULTS: No eyes in Group I received AMT for SJS/TEN, compared to 87% of qualifying eyes in Group II (P < .0001) There was a significant difference in the proportion of eyes with BCVA ≥20/40 at last follow-up between Group I and Group II (33% vs 92%, P < .001). The proportion of eyes with vision-threatening complications in the chronic phase was significantly higher in Group I versus Group II (67% vs 17%, P = .002), with most complications occurring in the first 2 years after disease onset in both groups. CONCLUSIONS: A specific protocol for acute ocular care in SJS/TEN, including aggressive use of AMT, was highly successful in reducing corneal blindness and severe vision-threatening complications of the disorder.
PURPOSE: To describe the long-term effect of a treatment protocol for ocular involvement in acute Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN), including focused ocular examination and pathology-appropriate use of lubrication, topical corticosteroids, topical antibiotics, and amniotic membrane transplantation (AMT). DESIGN: Retrospective, comparative case series. METHODS: A total of 48 patients (96 eyes) were included in this study. Nine of 48 patients (18 eyes) had acute SJS/TEN from 2000 to 2007 and did not receive protocol care (Group I). Thirty-nine of 48 patients (78 eyes) had acute SJS/TEN from 2008 to 2017 and received protocol care (Group II). The main outcome measures were best-corrected visual acuity (BCVA) at final follow-up visit and incidence of complications in the chronic phase. RESULTS: No eyes in Group I received AMT for SJS/TEN, compared to 87% of qualifying eyes in Group II (P < .0001) There was a significant difference in the proportion of eyes with BCVA ≥20/40 at last follow-up between Group I and Group II (33% vs 92%, P < .001). The proportion of eyes with vision-threatening complications in the chronic phase was significantly higher in Group I versus Group II (67% vs 17%, P = .002), with most complications occurring in the first 2 years after disease onset in both groups. CONCLUSIONS: A specific protocol for acute ocular care in SJS/TEN, including aggressive use of AMT, was highly successful in reducing corneal blindness and severe vision-threatening complications of the disorder.
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Authors: D Thorel; S Ingen-Housz-Oro; G Royer; A Delcampe; N Bellon; C Bodemer; A Welfringer-Morin; D Bremond-Gignac; M P Robert; M Tauber; F Malecaze; O Dereure; V Daien; A Colin; C Bernier; C Couret; B Vabres; F Tetart; B Milpied; T Cornut; B Ben Said; C Burillon; N Cordel; L Beral; N de Prost; P Wolkenstein; M Muraine; J Gueudry Journal: Orphanet J Rare Dis Date: 2020-09-22 Impact factor: 4.123