New Grading System for the Evaluation of Chronic Ocular Manifestations in Patients with Stevens–Johnson Syndrome
Received 25 May 2006; accepted 26 October 2006. published online 02 May 2007.
Purpose
To evaluate and grade the extent and severity of chronic ocular manifestations in Stevens–Johnson syndrome (SJS).
Design
Prospective multicenter case series.
Participants
We enrolled 73 patients (138 eyes) with SJS seen between April 2003 and March 2005 at 3 tertiary referral centers.
Methods
Patients with a confirmed history of SJS and chronic ocular complications that persisted for at least 1 year from the onset of SJS were included. Their detailed medical history and ophthalmic examination results were recorded on an itemized data collection form. Complications were categorized as corneal, conjunctival, and eyelid complications, and 13 components were evaluated and graded on a scale from 0 to 3 according to their severity.
Main Outcome Measures
These were broadly classified as corneal (superficial punctate keratopathy, epithelial defect, loss of the palisades of Vogt, conjunctivalization, neovascularization, opacification, keratinization), conjunctival (hyperemia, symblepharon formation), and eyelid (trichiasis, mucocutaneous junction involvement, meibomian gland involvement, punctal damage) complications.
Results
The most severely affected complication components were loss of the palisades of Vogt (114 eyes; 82.6%) and meibomian gland involvement (102 eyes; 73.9%). Visual acuity in 74 of the 138 eyes (53.6%) was worse than 20/200. The severity of corneal, conjunctival, and eyelid complications was significantly correlated with visual loss. All 13 complications were correlated significantly with logarithm of the minimum angle of resolution (logMAR) visual acuity; the correlation coefficient (R) ranged from 0.359 to 0.810 (P<0.0001); for corneal epithelial defects, R was 0.169 (P = 0.0473). Eyes with a higher total score for the 3 complication categories had poorer vision (R = 0.806; P<0.0001). Multivariate regression analysis showed that corneal neovascularization, opacification, keratinization, and cataracts significantly affected logMAR visual acuity (P<0.0001, P<0.0001, P = 0.0142, P = 0.0375, respectively).
Conclusions
The authors describe a new method for grading the extent and severity of ocular involvement in patients with SJS and demonstrate that the severity of ocular involvement is correlated significantly with the final visual outcome. This new grading system provides a more objective method for evaluating SJS patients and may be adapted for use in other cicatricial ocular surface diseases.
1Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan.
2Department of Ophthalmology, School of Medicine, Keio University, Tokyo, Japan.
3Department of Ophthalmology, Tokyo Dental College, Chiba, Japan.
4National Institute of Sensory Organs, National Tokyo Medical Center, Tokyo, Japan.
Correspondence to Chie Sotozono, MD, PhD, Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kawaramachi Hirokoji, Kamigyo-ku, Kyoto 602-0841 Japan.
Manuscript no. 2006-570.
The authors have no financial interest in this work.
Supported in part by grants-in-aid for scientific research from the Ministry of Education, Culture, Sports, Science and Technology, Tokyo, Japan, and grants from the Ministry of Health, Labor, and Welfare, Tokyo, Japan.
ABSTRACT