Although rare, Stevens-Johnson syndrome (SJS) is a serious autoimmune disorder often brought on by an allergic drug reaction that, if left untreated, can cause ocular dryness, ocular pain and even permanent vision loss, not to mention systemic issues.1
Because blindness is a potential result, clinicians are careful not to miss this diagnosis, and to ensure any patients diagnosed with it are not lost to follow up. Two new studies in the American Journal of Ophthalmology are helping doctors use technology to combat that condition by characterizing the disease more precisely as well as taking steps to halt its progression.1,2
One of the studies looked at topographical patterns of patients in the chronic phase of SJS, as well as toxic epidermal necrolysis (TEN), to quantify the higher-order aberrations of the cornea. These researchers examined 84 eyes and found that those with chronic SJS had significantly larger higher-order aberrations than normal controls.2 Using OCT, the researchers identified ectasia patterns in 16 eyes (19.0%), asymmetric patterns in 28 eyes (33.3%), flattening patterns in 11 eyes (13.0%) and minimal change pattern in 29 eyes (34.5%).2 The researchers were able to show that minimal change pattern and asymmetric patterns were common in SJS as well as TEN and that higher-order corneal aberrations were associated with decreased visual acuity in both types of patients.2
Another study shows encouraging results for SJS patients treated with amniotic membranes.3 The researchers reviewed the records of 78 eyes diagnosed with SJS or TEN that had amniotic membranes applied and 18 eyes that did not receive this treatment. The proportion of eyes with vision-threatening complications in the chronic phase was significantly higher in the non-amniotic membrane group than in those who did receive the treatment. In the group that didn’t receive the treatment, 67% developed such complications. In the amniotic membrane group, only 17% did, with most complications occurring in the first two years in both groups.3
This protocol for monitoring with topography and OCT, and treating with amniotic membranes, could potentially defang this rare, but serious, condition.
1. Stevens-Johnson syndrome. American Academy of Ophthalmology. www.aao.org/bcscsnippetdetail.aspx?id=f2b83f29-d29e-4835-9d42-feba8de11895. Accessed July 25, 2019.
2. Ibrahim O, Yagi-Yaguchi Y, Noma H, et al. Corneal higher-order aberrations in Stevens-Johnson syndrome and toxic epidermal necrolysis. Am J Ophthalmol. July17, 2019 [Epub ahead of print].
3. Shanbag S, Rashad R, Chodosh J, Saeed H. Long-term impact of a treatment protocol for acute ocular involvement in Stevens-Johnson syndrome/toxic epidermal necrolysis. Am J Ophthalmol. July 19, 2019 [Epub ahead of Print].