A cross-sectional study on chronic ocular manifestations of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) in Chinese eyes: a 15 year case series

Abstract

PURPOSE: To compare the chronic ocular manifestations in SJS and TEN patients from a 15 years cohort of Chinese patients. SETTING: Queen Mary Hospital, a tertiary burn referral center in Hong Kong. METHODS: All SJS and TEN patients from a 15 years cohort, admitted between the years 1999 to 2014, were invited for a detailed assessment of their chronic ocular sequelae. All patients underwent a detailed slit lamp examination in which their ocular condition was graded according to the Sotozono Scoring System, which depended on the extent of cornea, conjunctiva and lid involvement. Tear Osmolarity (Tear Lab) was also measured. Statistical evaluation was performed by Mann-Whitney test and the Spearman's correlation. p< 0.05 was regarded as statistically significant. RESULTS: 18 SJS and 5 TEN cases were included. The average age of onset was 46.2+/-17.2 for SJS and 46.4+/-19.2 for TEN. All of the cases were drug-induced. The LogMAR visual acuity was 0.209+/-0.591 in SJS and 0.489+/-0.688 in TEN patients(p=0.048). The average total Sotozono score was 3.75+/-7.32 in SJS and 6.90+/-8.43 in TEN patients(p=0.152). There was a statistically significant correlation between Sotozono score and LogMAR VA(r0= 0.437,p=0.003). Conjunctiva involvement was statistically significant when comparing between the 2 groups(p<0.004), however, there was no statistically significant difference found in cornea(p=0.0406) and lid involvement(p=0.117). The average tear osmolarity was 324.9+/-20.4 in SJS and 320.3+/-22.6 in TEN patients(p=0.497). There was no significant correlation between tear osmolarity and Sotozono score(r0 = 0.038, p=0.828). CONCLUSIONS: The most common chronic ocular manifestation in both SJS and TEN is superficial punctate keratopathy. There is no statistical significant difference in the Sotozono scoring score of both groups. Both groups demonstrated an elevated tear osmolarity indicative of inflammatory dry eyes, however, there was no statistical significant difference between the two groups.