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C. Sotozono, Y. Araki, T. Inatomi, M. Ueta, N. Yokoi, S. Kinoshita; Successful Treatment of Stevens-Johnson Syndrome With High-Dose Corticosteroid Pulse Therapy at Disease Onset. Invest. Ophthalmol. Vis. Sci. 2008;49(13):1911.
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To evaluate the visual prognosis of patients with Steven-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) followed by therapy with general and topical high-dose corticosteroids from the disease onset.
High-dose methylpredonisolone and intensive topical betamethasone was started immediately after the dermatological and ophthalmological diagnosis.Intravenous methylpredonisolone at a dosage of 500 or 1000 mg/day was initially used for 3~4 days (steroid pulse). Topically, 0.1% betamethasone was used more than 5 times daily for at least 2 weeks as initial treatment.Main outcome measurement: Visual acuity and corneal-, conjunctival- and lid complications one year from the onset were examined.
All patients had pseudomembranous conjunctivitis at the first examination. Corneal or conjunctival epithelial defects were present in 7 out of 10 eyes. After starting systemic and topical corticosteroids, skin eruptions began to diminish. Although pseudomembranous conjunctivitis and epithelial defects worsened during the first several days from their onset, corneal epithelial defects healed within 2 weeks (mean: 5.2 days) and conjunctival epithelial defects within 6 weeks (mean: 13.0 days). At the chronic stage, all eyes had clear corneas and best corrected visual acuity of all eyes was more than 20/20. No eyes had the appearance of the loss of the palisades of Vogt, or cicatricial changes of the cornea and conjunctiva except one eye with fornix shortening. Superficial punctate keratitis was present in 5 eyes due to dry eye and no eyes had the appearance of epithelial defect. No significant adverse effects of steroid application, such as sepsis, keratitis, or increase of intra-ocular pressure, occurred during all clinical courses.
High-dose pulse therapy with corticosteroids at the onset is of great therapeutic importance in preventing ocular complications. Topical betamethasone during the acute stage shows great promise for preventing the loss of limbal stem cells and corneal- and conjunctival cicatricial changes.
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