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DongHyun Kim, Mee Kum Kim, Kyung Chul Yoon, Hyo Seok Lee, Kyoung Yul Seo, Sang Chul Yoon; Prognostic factors in chronic complications of Stevens-Johnson syndrome and toxic epidermal necrolysis. Invest. Ophthalmol. Vis. Sci. 2014;55(13):5534.
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To investigate prognostic factors in chronic ocular complications of Stevens-Johnson syndrome (SJS) or Toxic epidermal necrolysis (TEN) patients, we analyzed systemic and ocular factors in acute stages and effect of early treatment modalities on chronic complications.
The medical records of the 86 eyes in 43 patients who had been diagnosed as SJS/TEN were retrospectively reviewed. Main outcome measures were final VA and grading of chronic ocular surface complications(GCOC, 0-15). Age, sex, causative drugs, initial visual acuity(VA), grading of the ocular complication at onset (0-3), grading of the systemic involvement at onset (0-16), systemic steroid dosage, intravenous immunoglobulin (IVIG) dosage, amniotic membrane transplantation(AMT) were analyzed as prognostic factors to be related with poor final VA (less than 20/200) and high GCOC (more than 8 points).
Grading of the systemic involvement at onset in IVIG therapy alone, combination therapy of steroid and IVIG, steroid therapy group were significantly higher than that of conservative treatment group (p<0.001, Kruskal Wallis test). Final VA and GCOC were not significantly different depending on the treatment modalities despite of correcting the patients’ demographics (p=0.169, 0.117, Nonparametric ANCOVA). Poor final VA was related with initial AMT and high GCOC were related with women or AMT. (p=0.048/p=0.012, 0.040, Multiple logistic regression).
The facts that female or initial AMT due to severe ocular surface complication at onset suggest worse chronic ocular complications in SJS/TEN as prognostic factors.
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