Predictive Factors Associated With Acute Ocular Involvement in Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis

• Published in: American journal of ophthalmology 2015-08, Vol.160 (2), p.228-237.e2
• Main Authors: Sotozono, Chie, Ueta, Mayumi, Nakatani, Eiji, Kitami, Amane, Watanabe, Hideaki, Sueki, Hirohiko, Iijima, Masafumi, Aihara, Michiko, Ikezawa, Zenro, Aihara, Yukoh, Kano, Yoko, Shiohara, Tetsuo, Tohyama, Mikiko, Shirakata, Yuji, Kaneda, Hideaki, Fukushima, Masanori, Kinoshita, Shigeru, Hashimoto, Koji
• Format: Article
• Language: English
• Subjects: Acute Disease; Antibiotics; Cold remedies; Confidence intervals; Conjunctiva - pathology; Cornea - pathology; Defects; Dermatology; Disease; Eye Diseases - diagnosis; Eye Diseases - epidemiology; Eye Diseases - etiology; Family medical history; Female; Follow-Up Studies; Gangrene; Humans; Incidence; Inflammation; Male; Medical personnel; Medical records; Middle Aged; Mortality; Nonsteroidal anti-inflammatory drugs; Ophthalmology; Prognosis; Retrospective Studies; Risk Assessment - methods; Sclera - pathology; Side effects; Skin; Stevens-Johnson Syndrome - complications; Stevens-Johnson Syndrome - diagnosis; Studies
• ISSN: 0002-9394; 1879-1891
• DOI: 10.1016/j.ajo.2015.05.002

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.