July 2019
Volume 60, Issue 9
Open Access
ARVO Annual Meeting Abstract  |   July 2019
Comparing the Severity of Chronic Ocular Complications in Lamictal vs. Trimethoprim/Sulfamethoxazole Induced Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis
Author Affiliations & Notes
  • Ramy Rashad
    Cornea Service, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, United States
    Tufts University School of Medicine, Boston, Massachusetts, United States
  • Swapna S. Shanbhag
    Cornea Service, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, United States
  • James Chodosh
    Cornea Service, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, United States
  • Hajirah N. Saeed
    Cornea Service, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, United States
  • Footnotes
    Commercial Relationships   Ramy Rashad, None; Swapna Shanbhag, None; James Chodosh, None; Hajirah Saeed, None
  • Footnotes
    Support  National Center for Advancing Translational Sciences, National Institutes of Health, Award Number TL1TR001062
Investigative Ophthalmology & Visual Science July 2019, Vol.60, 2522. doi:
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      Ramy Rashad, Swapna S. Shanbhag, James Chodosh, Hajirah N. Saeed; Comparing the Severity of Chronic Ocular Complications in Lamictal vs. Trimethoprim/Sulfamethoxazole Induced Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis. Invest. Ophthalmol. Vis. Sci. 2019;60(9):2522.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : The aim of this study is to compare the severity of chronic ocular complications of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) induced by lamotrigine (LT) vs. trimethoprim/sulfamethoxazole (TS).

Methods : This retrospective cross-sectional study evaluated all SJS and TEN patients treated within our hospital network from 2008 to 2018. Inclusion criteria included patients with reactions identified as caused by either LT or TS, and patients with at least one ophthalmology follow up in the chronic phase (≥ 3 months from onset of disease). Primary outcome measures included LogMAR VA at most recent visit and the presence or absence of severe ocular complications (SOC), defined as requiring one or more of the following interventions: a prosthetic replacement of the ocular surface ecosystem (PROSE) device, a lid mucous membrane graft (MMG), or a keratoprosthesis. Secondary outcome measures included modified Sotozono chronic ocular complication severity scores. Potential covariates were analyzed via regression models.

Results : Twenty-three patients were included in the study, 11 in the LT group and 12 in the TS group. The mean age of patients in each group was 27.91±18.43 years vs. 29.33±12.60 years, respectively. The mean duration of follow-up in months was 38.09±34.36 vs. 48.17±33.09, respectively. The LT group showed worse average visual acuity at the most recent visit (LogMAR VA; 0.752 vs. 0.041, p=0.0003) and had a higher prevalence of severe ocular complications than the TS group (72.7% vs. 8.33%, p=0.0003). The LT group also scored higher on the cornea (2.454 vs. 0.5, p=0.026), lid margin (6.454 vs. 3.083, p=0.009), and overall Sotozono scores (10.273 vs. 4.833, p=0.014). No statistical difference was found between the two groups on conjunctival scores (p=0.711) or survival time analysis (p=0.470). Neither age, race, gender, disease type (SJS vs. TEN) or duration of follow-up predicted visual acuity, the development of SOC, or overall Sotozono score.

Conclusions : Compared to patients with TS-induced disease, patients with SJS/TEN induced by LT developed worse chronic ocular complications on several parameters. Future prospective studies are warranted to provide additional insight into the drug type as a predictor of chronic ocular complications and to better inform acute and chronic management accordingly.

This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.

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