Severity of acute ocular involvement is independently associated with time to resolution of ocular disease in toxic epidermal necrolysis patients

Heng, Jacob S; Malik, Nabeel; Joshi, Naresh; Hayes, Michelle; Jones, Isabel; Fuller, L.C.; Vizcaychipi, Marcela P.

doi:10.1136/bjophthalmol-2014-305506

Cited by 5 publications

(3 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, Morales et al reported that although ocular damage in the acute stage was more frequent in patients with epidermal detachment >10% of the total body surface area, the SCORTEN value did not correlate with the severity of eye involvement in the acute stage ( 34 ). Heng et al reported that the grading of acute ocular disease severity does not correlate with systemic disease severity but is significantly associated with the time to resolution of ocular involvement in TEN ( 35 ). Yip et al also stressed that the severity of acute ocular disease and abnormal laboratory tests were not found to be significant risk factors for late complications ( 36 ).…”

Section: Discussionmentioning

confidence: 99%

Clinical Aspects of Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis With Severe Ocular Complications in Taiwan

et al. 2021

View full text Add to dashboard Cite

Purpose: Over the last decade, there has been tremendous progress in the treatment of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). To understand whether this has resulted in better ophthalmic outcomes, we aimed to study the incidence of severe ocular complications (SOCs) in the acute and chronic stage among SJS/TEN patients, major causative medications, and therapeutic effect of medical and surgical treatment.Methods: Using electronic medical records review of patients of Chang Gung Memorial Hospital Linkou Branch from 2010 to 2020, 119 patients (236 eyes) received ophthalmic consultation during the acute stage and were retrospectively studied. Sotozono's grading score systems for acute and chronic SJS/TEN were employed for accessing correlation between acute and chronic presentations, the therapeutic effect of systemic etanercept treatment, and outcome of early amniotic membrane transplantation (AMT) performed in patients with severe acute SOCs.Results: There were 46 male and 73 female patients with a mean age of 45.6 ± 22.7 years old (2–90 years), and follow-up time of 408.3 ± 351.0 (116–1,336) days. The numbers of patients with SJS, overlap syndrome, and TEN were 87, 9, and 23, respectively. In total, 109 eyes (55 patients) had acute SOCs, which comprised 46.2% of patients who underwent ophthalmic examination. Antiepileptics were the most common category of culprit drugs causing SOCs in the acute stage. At the end of follow-up, there were 14 eyes (9 patients) with chronic SOCs (5.9%), and non-steroidal anti-inflammatory drugs and cold medicine were the most common causative medications that were associated with severe chronic sequela. The correlation between Sotozono's acute and chronic grading score showed a positive relationship [Spearman's rank correlation coefficient (r) = 0.52, p < 0.001]. The average chronic grading scores in patients receiving systemic corticosteroid combined with etanercept treatment were significantly lower than those receiving corticosteroid only, Finally, the average chronic grading scores in patients receiving AMT <7 days after onset were significantly lower than those performed beyond 7 days.Conclusion: Our study implies that acute manifestation can be an indicator for chronic sequelae. Additional early etanercept treatment and early AMT showed beneficial effect in reducing chronic ocular sequela.

show abstract

Section: Discussionmentioning

confidence: 99%

Clinical Aspects of Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis With Severe Ocular Complications in Taiwan

et al. 2021

View full text Add to dashboard Cite

show abstract

“…Ocular involvement may precede or follow cutaneous disease and occurs in 50-90% of patients. 27,[42][43][44][45][46][47][48] Acute ocular findings range from conjunctival hyperemia to loss of the entire ocular surface and eyelid margin epithelium. 45,49,50 The severity of ocular involvement disease has not been reliably correlated with the severity of skin disease or SCORTEN.…”

Section: Ocular Carementioning

confidence: 99%

Society of Dermatology Hospitalists supportive care guidelines for the management of Stevens-Johnson syndrome/toxic epidermal necrolysis in adults

Seminario‐Vidal

Kroshinsky

Malachowski

et al. 2020

Journal of the American Academy of Dermatology

View full text Add to dashboard Cite

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are life-threatening conditions with high morbidity and mortality. Supportive care management of SJS/TEN is highly variable. A systematic review of the literature was performed by dermatologists, ophthalmologists, intensivists and gynecologists with expertise in SJS/TEN to generate statements for supportive care guideline development. Members of the Society of Dermatology Hospitalists (SDH) with expertise in SJS/TEN were invited to participate in a modified, online Delphi-consensus. 9-point Likert scale questionnaires regarding 135 statements were administered. The RAND/UCLA appropriateness method was employed to evaluate and select proposed statements for guideline inclusion; statements with median ratings of 6.5-9 and disagreement index ≤1 were included in the guideline. For the final round, the guidelines were appraised by all the participants. An evidence-based discussion and recommendations for hospital setting and care team, wound care, ocular care, oral care, urogenital care, pain management, infection surveillance, fluid and electrolyte management, nutrition and stress ulcer prophylaxis, airway management, and anticoagulation in adult patients with SJS/TEN are included.

show abstract

“…Other studies have also emphasized that no correlation has been found between systemic involvement and ocular involvement severity. [ 13 20 21 ] Ocular treatment needs to be started simultaneously to the systemic treatment in the acute stage.…”

Section: Discussionmentioning

confidence: 99%

Ocular manifestations in acute stage Stevens-Johnson syndrome/toxic epidermal necrolysis - A retrospective study in a tertiary hospital in South India

Shetti

Pradeep

2022

Taiwan Journal of Ophthalmology

View full text Add to dashboard Cite

PURPOSE: To describe the ocular manifestations in the acute stage of Stevens-Johnson syndrome/ toxic epidermal necrolysis. MATERIALS AND METHODS: We reviewed all the medical records of patients diagnosed with Stevens-Johnson syndrome/ toxic epidermal necrolysis and erythema multiforme between 2012 and 2019. Demographics, ophthalmic manifestations, and the treatment given systemically and locally were reviewed and analyzed. RESULTS: We had forty-five patients admitted to our hospital between Jan 2012 to Dec 2019 with SJS/TEN as a diagnosis.Twenty-six (57.5%) of them were females, and 19(42.2%) were males. The mean age was 27.5 years.Forty (88.9%) of our cases were diagnosed as Stevens-Johnson syndrome, and five (11.9%) as toxic epidermal necrolysis. We found antiepileptics as a triggering agent in thirteen cases (28.8%). Fever (84.4%) and mucosal lesions (86.7%) were the most common presenting symptom. We found ocular symptoms in only 22 (48.9%) patients. The treating physicians referred only thirty-one cases to the ophthalmologist, out of which 22 cases were referred within three days of admission. The most common ocular involvement was conjunctival congestion (69%). Ocular grading showed that mild grade included 42.9%, moderate grade 28.6%, and severe grade 28.6% of the cases. The ocular treatment involved medical management with lubricating drops (100%), topical steroids (58.6%), and topical antibiotics (68.9%). Five individuals with a severe grade of ocular involvement underwent amniotic membrane transplantation. CONCLUSION: Ocular examination and grading are essential in the acute stage of SJS/TEN. It helps the ophthalmologist recognize the sentinel findings and institute appropriate treatment in the acute stage as early as possible.

show abstract

Severity of acute ocular involvement is independently associated with time to resolution of ocular disease in toxic epidermal necrolysis patients

Cited by 5 publications

References 23 publications

Clinical Aspects of Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis With Severe Ocular Complications in Taiwan

Clinical Aspects of Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis With Severe Ocular Complications in Taiwan

Society of Dermatology Hospitalists supportive care guidelines for the management of Stevens-Johnson syndrome/toxic epidermal necrolysis in adults

Ocular manifestations in acute stage Stevens-Johnson syndrome/toxic epidermal necrolysis - A retrospective study in a tertiary hospital in South India

Contact Info

Product

Resources

About