W E I L L . C O R N E L L . E D U

Outcomes of Acute Intervent ions for SJS/TEN Using a Novel Grading Scale and Treatment Algor i thm

Wo r l d C o r n e a C o n g r e s s V I I

J e s s i c a B . C i r a l s k y, K e l l e y J . B o h m , C e c i l i a N i c o l , A n a G . A l z a g a - F e r n a n d e z , M a r k I . R o s e n b l a t t , K i m b e r l y C . S i p p e l .

T h e a u t h o r s h a v e n o r e l e v a n t f i n a n c i a l i n t e r e s t s t o d i s c l o s e .

A p r i l 1 5 – 1 7 , 2 0 1 5

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INTRODUCTION• Ophthalmic interventions during the acute phase of

Stevens-Johnson Syndrome (SJS) and toxic epidermal necrolysis (TEN) have been shown to improve ophthalmic outcomes.

• In this study, we aim to assess our long-term outcomes of patients with acute SJS or TEN who were treated acutely according to a novel acute stage grading scale and associated treatment algorithm.

METHODS

• Retrospective case series: – 18 patients, 36 eyes

• Inclusion criteria:– Biopsy proven SJS or TEN– Ophthalmic involvement of any degree– Presented within 7 days of disease onset– At least 1 month of follow-up

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ACUTE STAGE GRADING SCALE

GRADING SCALE CLINICAL DESCRIPTION

MILD CONJUNCTIVITIS WITH CONJUNCTIVAL SLOUGHING

MODERATE LOCALIZED MODERATE CONJUNCTIVAL SLOUGHING

SEVERE PROGRESSIVE, EXTENSIVE CONJUNCTIVAL SLOUGHING &/OR CORNEAL INVOLVEMENT

EXTREME EXTENSIVE SLOUGHING OF CONJUNCTIVA, LID MARGINS AND CORNEA

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AC U T E STAG E G R A D I N G S C A L E & T R EAT M E N T A LG O R I T H M

GRADING SCALE CLINICAL DESCRIPTION TREATMENT

MILD CONJUNCTIVITIS WITH CONJUNCTIVAL SLOUGHING

ARTIFICIAL TEARS AND LOCAL STEROIDS

MODERATE LOCALIZED MODERATE CONJUNCTIVAL SLOUGHING

LOCAL STEROIDS AND LARGE DIAMETER BANDAGE

CONTACT LENS

SEVERE PROGRESSIVE, EXTENSIVE CONJUNCTIVAL SLOUGHING

&/OR CORNEAL INVOLVEMENT

AMNIOTIC MEMBRANE APPLICATION

EXTREME EXTENSIVE SLOUGHING OF CONJUNCTIVA, LID MARGINS

AND CORNEA

MULTIPLE AMNIOTIC MEMBRANE APPLICATIONS

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RESULTS

• Outcomes measure:– Visual Acuity

• 14 patients, 28 eyes

–100% achieved 20/40 or better vision

• 4 patients, 8 eyes– Unable to measure visual acuity formally due to age or altered

mental status

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RESULTS

• Severe: Amniotic membrane applicationFEW MONTHS LATERACUTE STAGE

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RESULTS

• Outcome measure:– Corneal clarity

• 34 of 36 eyes (94%)– Completely clear corneas

• 2 of 36 eyes (6%) – Mild corneal opacification– Both eyes still had 20/40 or better vision

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RESULTS

• Severe: Amniotic membrane applicationFEW MONTHS LATERACUTE STAGE

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RESULTS

• Extreme: Multiple amniotic membrane applicationsFEW MONTHS LATER

ACUTE STAGE

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CONCLUSIONS

• Excellent outcomes were achieved in our patients with acute SJS or TEN by classifying the severity of ophthalmic involvement using a novel acute stage grading scale and then treating according to an associated treatment algorithm.

W E I L L . C O R N E L L . E D U

Sources

Acknowledgements

Weill Cornell Dept. of Ophthalmology

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• Gregory DG, Stevens-Johnson Syndrome: A New Grading System For The Acute Ocular Manifestations. 6th World Cornea Congress. Boston. April 8, 2010.