Abstract
Purpose :
Stevens-Johnson syndrome / toxic epidermal necrolysis (SJS/TEN), are acute self-limiting diseases of the skin and mucous membranes, which predispose patients to life-threatening complications. Ocular complications in SJS/TEN, which can range from mild to severe, occur acutely in up to 90% of patients; up to 80% suffer from long-term complications. This study evaluated the differences in ocular complications of SJS / TEN in patients receiving either systemic Intravenous Immunoglobulin (IVIG) or Ciclosporin A (CsA) as initial treatments.
Methods :
Retrospective review of consecutive patients admitted for SJS/TEN at a tertiary dermatological referral centre over a 7-year period who received either IVIG or Ciclosporin and had ophthalmological follow-up more than 6 months were included. Baseline demographic, ocular and systemic data were compared. Acute ocular severity of SJS/TEN was graded using the Gregory grading score; chronic ocular complications were graded using the Sotozono system. The worse eye was used for analysis.
Results :
18 subjects were included for analysis, 8 in the IVIG group and 10 in the CsA group. There were no significant differences between the 2 treatment groups in terms of acute Gregory severity grading of cornea, conjunctival, or lid involvement at presentation. Subjects in the CsA group had a trend towards worse overall Sotozono grading scores compared to those in the IVIG group (6.22 + 4.27 vs 2.62 + 1.20, p = 0.27); in particular, there was a higher incidence of corneal and eyelid complications in the former group. Subjects in the CsA group also had a significantly higher incidence of ocular intervention, with 1 subject (10%) needing an amniotic membrane transplant and 1 (10%) needing repeated penetrating keratoplasties, compared to none in the IVIG group. Additionally, SJS/TEN patients with worse acute ocular involvement were more likely to have TEN and extra-ocular mucosal involvement (p=0.01).
Conclusions :
SJS/TEN patients who received CsA at the acute disease stage, had worse chronic corneal and eyelid complications and were more likely to need long term ophthalmic follow-up and surgical ocular interventions, compared to those who received IVIG. TEN and extra-ocular mucosal involvement were associated with worse acute ocular SJS/TEN involvement. Further studies are required to validate these findings.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.