Corneal Higher-order Aberrations in Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis

Abstract

Purpose : To characterize the topography patterns and quantify corneal higher-order aberrations (HOAs) in the chronic phase of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN).

Methods : Retrospective, descriptive, consecutive case series. The study included eighty-six eyes of 49 patients in the chronic phase of SJS/TEN who presented at Tokyo Dental College from January 2010 to June 2018. Sotozono grading system (AJO 2015) was applied. HOAs of the total cornea, and of the anterior and posterior surfaces were measured using anterior segment optical coherence tomography (AS-OCT) (SS-1000, CASIA, Tomey, Japan). Corneal topography patterns were classified into one of the 4 types: ectasia-, asymmetric-, flattening- and minimal change- patterns. We also evaluated the association among topography patterns, corneal thinning, and epithelial hyperplasia using AS-OCT images. The correlation between corneal HOAs and visual acuity was evaluated.

Results : The mean interval between the onset of SJS/TEN and the present analysis was 17.1 ± 16.0 years. Mean logarithm of the minimal angle of resolution (logMAR) visual acuity was 0.93 ± 0.95 (Sotozono grade: 15.5±8.7). AS-OCT showed ectasia pattern in 16 eyes (18.6%), asymmetric pattern in 28 eyes (32.6%), flattening pattern in 11 eyes (12.8%) and minimal change pattern in 29 eyes (33.7%). The HOAs of the total cornea were 1.23±1.04 μm within a 4-mm diameter and 2.19±1.82 μm within a 6-mm diameter, which were significantly larger than those in normal controls (P<0.0001). LogMAR visual acuity was significantly correlated with corneal HOAs (4-mm: r=0.793, P<0.0001, 6-mm: r=0.798, P<0.0001). When the participants were stratified based on corneal opacity, logMAR visual acuity was significantly correlated with corneal HOAs within a 4-mm diameter in opacity grades 0 (35 eyes, r=0.649, P<0.0001), 1 (23 eyes, r=0.678, P=0.0004), and 2-3 (26 eyes, r=0.570, P=0.0024). Ectasia pattern was derived from either corneal thinning (68.7%) or epithelial hyperplasia (31.3%).

Conclusions : This study showed specific topography patterns in the chronic phase of SJS/TEN. Despite corneal opacity due to conjunctivalization or scarring, corneal HOAs were associated with decreased visual acuity stratified based on grade of corneal opacity. AS-OCT analysis provides more objective information for evaluation of optical quality and for selection of scleral contact lenses in SJS/TEN patients.

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