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Paul J. Tomlins, Geraint P. Williams, Matthew R. Edmunds, Saaeha Rauz; Prediction of Chronic Ocular Surface Disease in Acute Toxic Epidermal Necrolysis. Invest. Ophthalmol. Vis. Sci. 2011;52(14):6434.
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© ARVO (1962-2015); The Authors (2016-present)
Toxic Epidermal Necrolysis (TEN) is a rare life threatening immunobullous disease affecting the skin and mucous membranes including the ocular surface. Validated scoring systems such as SCORTEN have been used to predict mortality, but ocular involvement varies considerably. The aims of our study were to investigate the relationship between systemic and ocular surface disease (OSD) severity, and to compare the ability of the Power classification to a proposed novel acute TEN OSD scoring system, to predict the development of chronic OSD.
Patients presenting over a 9 year period to a Regional Burns Unit in the United Kingdom with a diagnosis of TEN were reviewed. SCORTEN was used to classify the severity of acute systemic disease. The presence of chronic OSD was investigated by a postal questionnaire to the patient’s family doctor. The degree of acute OSD was assessed using Power’s classification of disease outcome and a proposed more detailed acute OSD scoring scale which utilises 11 clinical features to provide a score ranging from 0-42.
28 cases were identified, of which 24 case-notes were available (19 female, median age 53[Range 17-84] years). Drugs were the most common precipitating factor 17/24 (71%) of which antibiotics were implicated in 9/17 (53%) cases. The SCORTEN ranged from 0-4 and 4/24 (17%) patients died from complications of TEN. Acute ocular surface involvement was defined in 15/20 (75%) cases, of whom 7/20 (35%) had severe inflammation according to Power’s classification. Data on chronic ocular problems were available for 12 patients, 6 of whom continued to have persistent OSD.There was a significant negative relationship between SCORTEN and the degree of acute ocular involvement using Power’s classification (r=-0.493; p=0.014). The proposed scoring system correlated well with Power’s score (r-0.87, p 9.5/42) than the Power classification (83% at scores which were moderate or severe).
The severity of systemic disease does not predict the extent of ocular involvement in acute TEN; indeed, in our series, the patients with the worst ocular surface disease had significantly lower SCORTEN. The proposed scoring system affords a higher specificity than Power’s score, but validation is required to determine whether this tool will enable the clinician to monitor the severity of acute TEN and more accurately predict chronic ocular sequelae.
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