Scleral Lens Therapy in Ocular Surface Disease Due to Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis

Abstract

Purpose: : To describe the therapeutic benefits of gas-permeable scleral lens (SL) in the management of patients with severe ocular surface disease associated with toxic epidermal necrolysis (TEN) and Stevens-Johnson syndrome (SJS).

Methods: : Clinical records of patients fitted with SL for refractory ocular surface disease due to SJS or TEN were retrospectively reviewed. Clinical parameters studied included visual acuity and complications related to SL use. To assess vision-specific quality of life, each patient completed the Ocular Surface Disease Index (OSDI) questionnaire and the National Eye Institute Visual Function Questionnaire (NEI VFQ-25) at baseline examination and 6 months after SL placement.

Results: : Thirty-nine patients were included in this study. The mean age was 35.8 ± 13.9 years (range, 7 to 65 years). SL fitting failed in 3 patients. The mean follow-up was 33.3 ± 17.6 months (range, 16 to 54 months). Among successfully fitted patients (36 patients, 64 eyes), visual acuity improved from 1.09 ± 0.74 to 0.52 ± 0.54 logMar (p<0.001) six months after SL placement and from 1.09 ± 0.74 to 0.11 ± 0.53 logMar (p < 0.001) at the last contact. The visual acuity improved by 2 or more Snellen lines in 35 of 64 eyes (54.7%). The mean OSDI improved from 76.9 ± 22.8 (range, 13.9 to 100) to 37.1 ± 26.7 (range, 2.1 to 79.2) six months after SL placement (p<0.001). Thirty-two NEI VFQ-25 composite scores were available. The mean NEI VFQ-25 composite score improved from 24.3 ± 17.1 (range, 1.8 to 80.9) to 67.4 ± 22.1 (range, 22.6 to 95.6) six months after SL placement (p<0.001). The use of the SL led to improvement of OSDI and NEI VFQ-25 composite score in all fitted patients. No serious adverse events or infections attributable to the SL occurred.

Conclusions: : Gas-permeable scleral lens use appears to be efficient and safe for the management and visual rehabilitation of patients with refractory ocular surface disease due to toxic epidermal necrolysis and Stevens-Johnson syndrome.

Keywords: cornea: tears/tear film/dry eye • clinical (human) or epidemiologic studies: outcomes/complications • contact lens