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Qin Long; The clinical evaluation of treatment for the ocular complications from Stevens-Johnson syndrome and toxic epidermal necrolysis. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):3062.
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To evaluate the treatment strategies for the ocular complications from Stevens-Johnson syndrome(SJS) and toxic epidermal necrolysis(TEN).
Ten patients with SJS/TEN were included in the study, the severity of illness score (SIS) was identified using SCORTEN. The severity of eye score (SES) was evaluated according to conjunctival hyperemia, conjunctival exudate, conjunctival pseudomembrane, corneal erosion, eyelid involving and lid margin involving. The treatment strategies were made according to the SIS and SES individually.
The mean SIS was (n=10,1.40±1.89), the mean SES was (n=20,7.00±3.58). According to the SIS and SES, patients at their acute stage received systemic methylprednisolone (1.5mg-2mg/Kg) W/O immunoglobulin(0.4g/Kg)for 3-5 days; ophthalmic cortical steroid (0.1% or 1%) W/O 0.05%-1% Cyclosporine A eye drops to inhibit ocular inflammation; for the eyes with severe ocular surface involvement, two eyes received amniotic membrane application, ten eyes received autoserum therapy. All the patients had artificial tear application to clean the conjunctival exudate and lubricate ocular surface. The convalescent treatment included topical 0.05% Cyclosporine A, artificial tear application or bandage contact lens wearing. After follow-up for 6-15 months, the ocular complication included moderate to severe dry eye (6 eyes), symblepharon (4 eyes), corneal neovascularization (2 eyes) and persistent corneal epithelial defection (4 eyes).
Sufficient systemic and ocular cortical steroid treatment and prompt amniotic membrane application in the patients with severe ocular involvement appear to result in reducing the acute ocular complications secondary to SJS/TEN. The late ocular complications were significantly related to the SES, but not SIS.
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