Abstract
Purpose :
The purpose of this retrospective review is to report on the demographics, therapeutic course, and visual outcomes of patients with SJS/TEN seen at Massachusetts Eye and Ear Infirmary (MEEI).
Methods :
Review of charts with relevant ICD codes from January 2009 to June 2015 was conducted. These charts included patients who were seen by MEEI in both the acute and chronic phases. There was limited access to the records of those seen in the acute phase in the ICU setting and results are separated into acute and chronic phase of disease. Only those charts which had electronic data available were reviewed.
Results :
128 charts of patients with a diagnosis of SJS/TEN between January 2009 and June 2015 were available for review. Of these, 60 were inpatient consultations and 68 were referrals for management of chronic disease. Of those 68 patients first seen in the chronic phase of disease, 45 presented with vision of counting fingers or worse in at least one eye. 20 of these patients underwent type 2 Boston keratoprosthesis surgery in at least one eye, and 12 underwent a type 1 keratoprosthesis surgery in at least one eye. As of most recent follow up, 13 of the operated eyes have maintained a vision of 20/200 or better (average 20/40, range 20/20 to 20/200). Patients seen in the acute phase received a range of treatments in the acute phase including topical steroid preparations, antibiotic prophylaxis, and amniotic membrane transplantation. No patients who received acute ocular care for SJS/TEN by MEEI underwent keratoprosthesis surgery. This group of patients maintained an average vision of 20/30 in either eye.
The etiologic agents for SJS/TEN in this cohort of patients was most commonly trimethoprim sulfamethoxazole (n= 20), followed by lamotrigine (n = 13), and ibuprofen (n = 12). The rest were a variety of classes of drugs. None of the patients in this cohort had an infectious etiology noted.
Conclusions :
SJS/TEN is a source of severe ocular surface disease that can result in blindness. Appropriate intervention in the acute phase of the disease can mitigate blinding sequelae. A standard protocol for the acute care of these patients is utilized at MEEI. Type 1 and type 2 Boston keratoprosthesis surgeries in carefully selected patients can significantly improve vision in this group of patients.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.