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Kelly Ma, Aristomenis Thanos, Ankoor Shah, Iason Mantagos; An acute damage score to guide surgical intervention in ocular Stevens-Johnson Syndrome. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):1601.
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Amniotic membrane transplantation (AMT) has been proven to be beneficial for acute ocular Stevens-Johnson syndrome (SJS) and its more severe variant, toxic epidermal necrolysis (TEN) (figure 1). However, proper patient selection and the ideal timing of surgery is challenging. Here, we propose a clinical tool in order to systematically assess patients with ocular findings in acute SJS and TEN, which aims to help clinicians objectively record exam findings and identify potential surgical candidates.
A retrospective chart review of all 89 SJS/TEN patients evaluated by the Department of Ophthalmology at Boston Children’s Hospital was performed, and 20 patients fulfilled the study criteria. Seven of our 20 patients received AMT and the remaining 13 patients were treated with supportive care in the acute phase. The initial clinical manifestations were used to devise an acute damage score (ADS) with a range 0-9 (figure 2). Final outcomes were assessed using a previously established chronic damage score (CDS) and compared between the two groups using a non-parametric t-test.1
ADS for patients treated supportively ranged from 1-6 (mean = 3.15) whereas ADS for patients that underwent AMT ranged from 3-5 (mean = 3.86). AMT patients had excellent long-term results with minimal complications with final visual outcome of 20/20 in all 14 eyes. Their CDS were low, also illustrating minimal sequelae, average 1.86, range 0-3 (chronic scale 0-39). In contrast, patients with ADS in the same range (≥3) treated with supportive care carried an average CDS was 4, range 0-14 (chronic scale 0-39). The CDS between these two cohorts were statistically significant (p = 0.039).
Our acute damage score provides a clinical tool towards a more systematic evaluation of the acute SJS/TEN patient and attempts to identify the proper surgical candidates who will benefit the most from AMT. Initial results suggest that acute damage scores of 3 or greater may prompt a risk/benefit analysis to proceed with AMT and thus preventing long term ocular morbidity.<br /> <br /> References:<br /> 1. Sotozono C, Ang LPK, Koizumi N et al. New Grading System for the Evaluation of Chronic Ocular Manifestations in Patients with Stevens-Johnson Syndrome. Ophthalmology. 2007;114:1294-1302.
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