Comprehensive Approach to Ocular Consequences of Stevens Johnson Syndrome - the Aftermath of a Systemic Condition

Overview

Journal Graefes Arch Clin Exp Ophthalmol

Specialty Ophthalmology

Date 2014 Jan 29

PMID 24469247

Citations 15

Authors

Geetha Iyer

Bhaskar Srinivasan

Shweta Agarwal

Seema Kamala Muralidharan

Sumathi Arumugam

Affiliations

Soon will be listed here.

Abstract

Background: Stevens Johnson Syndrome (SJS) can lead to end stage corneal blindness. This study describes the comprehensive treatment measures and their outcomes in the management of ocular sequelae and complications of SJS.

Methods: Four hundred sixty-four eyes of 232 patients of SJS who underwent surgical intervention (punctal cautery, mucus membrane grafting for lid margin keratinisation, fornix reconstructive procedures, tectonic procedures, keratoplasty and keratoprosthesis) were studied. It was a non-comparative, retrospective, interventional case series. The primary outcome was the change in the best corrected visual acuity (BCVA). Secondary outcome measures included an improvement in the ocular surface status as indicated by corneal epithelial fluorescein staining and Schirmer's I strip wetting.

Results: The BCVA and the ocular surface status improved and/or stabilized in > 70 % of eyes following punctal cautery (n = 160) and > 80 % of eyes following lid margin mucus membrane grafting (n = 238). BCVA improved in 50 % of eyes following fornix reconstructive procedures (n = 24) with COMET (n = 6), in 63.9 % eyes with the Prosthetic Replacement of the Ocular Surface Ecosystem (PROSE) lens (n = 36), in 81.8 % of eyes after cataract surgery (n = 22). A BCVA of ≥20/200 was achieved in 72.34 % of eyes following keratoprostheses procedures (n = 47). The mean duration of follow up was 53.3 ± 15.2 months.

Conclusion: The ocular sequelae of Stevens Johnson Syndrome can be blinding. They need to be identified and addressed early to retard the continued deterioration of the ocular surface. Our study aims to highlight the problem as well as the importance of comprehensive measures in the management of this potentially blinding disorder.

Citing Articles

The outcomes of corneal sight rehabilitating surgery in Stevens-Johnson syndrome: case series.

Peng R, Chi M, Xiao G, Qu H, Shen Z, Zhao Y BMC Ophthalmol. 2024; 24(1):205.

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Strategic combination of cultivated oral mucosal epithelial transplantation and postoperative limbal-rigid contact lens-wear for end-stage ocular surface disease: a retrospective cohort study.

Aziza Y, Imai K, Itoi M, Yoshioka H, Komai S, Kitazawa K Br J Ophthalmol. 2023; 108(8):1177-1183.

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Ocular surface involvement and histopathologic changes in the acute stage of Stevens-Johnson syndrome and toxic epidermal necrolysis: a cross-sectional study.

Liu Y, Feng J, Ren Y, Shi W, Kang H, Peng Y BMC Ophthalmol. 2023; 23(1):297.

PMID: 37400766 PMC: 10316600. DOI: 10.1186/s12886-023-03052-7.

Cataract surgery in ocular surface disease.

Priyadarshini K, Sharma N, Kaur M, Titiyal J Indian J Ophthalmol. 2023; 71(4):1167-1175.

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Perioperative nuances of cataract surgery in ocular surface disorders.

Agarwal S, Srinivasan B, Harwani A, Fogla R, Iyer G Indian J Ophthalmol. 2022; 70(10):3455-3464.

PMID: 36190027 PMC: 9789861. DOI: 10.4103/ijo.IJO_624_22.

References

Solomon A, Ellies P, Anderson D, Touhami A, Grueterich M, Espana E . Long-term outcome of keratolimbal allograft with or without penetrating keratoplasty for total limbal stem cell deficiency. Ophthalmology. 2002; 109(6):1159-66. DOI: 10.1016/s0161-6420(02)00960-0. View

Iyer G, Pillai V, Srinivasan B, Falcinelli G, Padmanabhan P, Guruswami S . Modified osteo-odonto keratoprosthesis--the Indian experience--results of the first 50 cases. Cornea. 2010; 29(7):771-6. DOI: 10.1097/ICO.0b013e3181ca31fc. View

Ang L, Sotozono C, Koizumi N, Suzuki T, Inatomi T, Kinoshita S . A comparison between cultivated and conventional limbal stem cell transplantation for Stevens-Johnson syndrome. Am J Ophthalmol. 2006; 143(1):178-80. DOI: 10.1016/j.ajo.2006.07.050. View

Wright P, Collin J . The ocular complications of erythema multiforme (Stevens Johnson syndrome) and their management. Trans Ophthalmol Soc U K (1962). 1983; 103 ( Pt 3):338-41. View

Nishida K, Yamato M, Hayashida Y, Watanabe K, Yamamoto K, Adachi E . Corneal reconstruction with tissue-engineered cell sheets composed of autologous oral mucosal epithelium. N Engl J Med. 2004; 351(12):1187-96. DOI: 10.1056/NEJMoa040455. View

Nakamura T, Inatomi T, Sotozono C, Amemiya T, Kanamura N, Kinoshita S . Transplantation of cultivated autologous oral mucosal epithelial cells in patients with severe ocular surface disorders. Br J Ophthalmol. 2004; 88(10):1280-4. PMC: 1772364. DOI: 10.1136/bjo.2003.038497. View

Liu J, Sheha H, Fu Y, Giegengack M, Tseng S . Oral mucosal graft with amniotic membrane transplantation for total limbal stem cell deficiency. Am J Ophthalmol. 2011; 152(5):739-47.e1. DOI: 10.1016/j.ajo.2011.03.037. View

Kinoshita S, Koizumi N, Nakamura T . Transplantable cultivated mucosal epithelial sheet for ocular surface reconstruction. Exp Eye Res. 2004; 78(3):483-91. DOI: 10.1016/j.exer.2003.09.004. View

Gomes J, Santos M, Ventura A, Donato W, Cunha M, Hofling-Lima A . Amniotic membrane with living related corneal limbal/conjunctival allograft for ocular surface reconstruction in Stevens-Johnson syndrome. Arch Ophthalmol. 2003; 121(10):1369-74. DOI: 10.1001/archopht.121.10.1369. View

10.

Sotozono C, Ang L, Koizumi N, Higashihara H, Ueta M, Inatomi T . New grading system for the evaluation of chronic ocular manifestations in patients with Stevens-Johnson syndrome. Ophthalmology. 2007; 114(7):1294-302. DOI: 10.1016/j.ophtha.2006.10.029. View

11.

Kaido M, Yamada M, Sotozono C, Kinoshita S, Shimazaki J, Tagawa Y . The relation between visual performance and clinical ocular manifestations in Stevens-Johnson syndrome. Am J Ophthalmol. 2012; 154(3):499-511.e1. DOI: 10.1016/j.ajo.2012.03.044. View

12.

Tan A, Tan D, Tan X, Mehta J . Osteo-odonto keratoprosthesis: systematic review of surgical outcomes and complication rates. Ocul Surf. 2012; 10(1):15-25. DOI: 10.1016/j.jtos.2012.01.003. View

13.

HOWARD G . The Stevens-Johnson syndrome. Ocular prognosis and treatment. Am J Ophthalmol. 1963; 55:893-900. View

14.

Gregory D . Treatment of acute Stevens-Johnson syndrome and toxic epidermal necrolysis using amniotic membrane: a review of 10 consecutive cases. Ophthalmology. 2011; 118(5):908-14. DOI: 10.1016/j.ophtha.2011.01.046. View

15.

Cher I . Blink-related microtrauma: when the ocular surface harms itself. Clin Exp Ophthalmol. 2003; 31(3):183-90. DOI: 10.1046/j.1442-9071.2003.00633.x. View

16.

Sayegh R, Ang L, Foster C, Dohlman C . The Boston keratoprosthesis in Stevens-Johnson syndrome. Am J Ophthalmol. 2008; 145(3):438-44. DOI: 10.1016/j.ajo.2007.11.002. View

17.

Maskati Q, Maskati B . Asian experience with the Pintucci keratoprosthesis. Indian J Ophthalmol. 2006; 54(2):89-94. DOI: 10.4103/0301-4738.25828. View

18.

Power W, Ghoraishi M, Merayo-Lloves J, Neves R, Foster C . Analysis of the acute ophthalmic manifestations of the erythema multiforme/Stevens-Johnson syndrome/toxic epidermal necrolysis disease spectrum. Ophthalmology. 1995; 102(11):1669-76. DOI: 10.1016/s0161-6420(95)30811-1. View

19.

Fideliz de la Paz M, Alvarez de Toledo J, Charoenrook V, Sel S, Temprano J, Barraquer R . Impact of clinical factors on the long-term functional and anatomic outcomes of osteo-odonto-keratoprosthesis and tibial bone keratoprosthesis. Am J Ophthalmol. 2011; 151(5):829-839.e1. DOI: 10.1016/j.ajo.2010.11.011. View

20.

Di Pascuale M, Espana E, Liu D, Kawakita T, Li W, Gao Y . Correlation of corneal complications with eyelid cicatricial pathologies in patients with Stevens-Johnson syndrome and toxic epidermal necrolysis syndrome. Ophthalmology. 2005; 112(5):904-12. DOI: 10.1016/j.ophtha.2004.11.035. View