Sotozono Chie, Ang Leonard P K, Koizumi Noriko, Higashihara Hisayo, Ueta Mayumi, Inatomi Tsutomu, Yokoi Norihiko, Kaido Minako, Dogru Murat, Shimazaki Jun, Tsubota Kazuo, Yamada Masakazu, Kinoshita Shigeru
Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Ophthalmology. 2007 Jul;114(7):1294-302. doi: 10.1016/j.ophtha.2006.10.029. Epub 2007 May 1.
To evaluate and grade the extent and severity of chronic ocular manifestations in Stevens-Johnson syndrome (SJS).
Prospective multicenter case series.
We enrolled 73 patients (138 eyes) with SJS seen between April 2003 and March 2005 at 3 tertiary referral centers.
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.
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.
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).
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.
评估并分级史蒂文斯-约翰逊综合征（SJS）慢性眼部表现的范围和严重程度。
前瞻性多中心病例系列研究。
我们纳入了2003年4月至2005年3月期间在3家三级转诊中心就诊的73例SJS患者（138只眼）。
纳入有确诊SJS病史且自SJS发病起持续至少1年的慢性眼部并发症患者。他们的详细病史和眼科检查结果记录在一份逐项数据收集表上。并发症分为角膜、结膜和眼睑并发症，并根据严重程度将13项指标按0至3级进行评估和分级。
这些指标大致分为角膜（浅层点状角膜炎、上皮缺损、Vogt栅栏消失、结膜化、新生血管形成、混浊、角化）、结膜（充血、睑球粘连形成）和眼睑（倒睫、黏膜皮肤交界处受累、睑板腺受累、泪点损害）并发症。
受影响最严重的并发症指标是Vogt栅栏消失（114只眼；82.6%）和睑板腺受累（102只眼；73.9%）。138只眼中有74只眼（53.6%）的视力低于20/200。角膜、结膜和眼睑并发症的严重程度与视力丧失显著相关。所有13项并发症均与最小分辨角对数（logMAR）视力显著相关；相关系数（R）范围为0.359至0.810（P<0.0001）；对于角膜上皮缺损，R为0.169（P = 0.0473）。3类并发症总分较高的眼视力较差（R = 0.806；P<0.0001）。多因素回归分析显示，角膜新生血管形成、混浊、角化和白内障显著影响logMAR视力（分别为P<0.0001、P<0.0001、P = 0.0142、P = 0.0375）。
作者描述了一种对SJS患者眼部受累范围和严重程度进行分级的新方法，并证明眼部受累的严重程度与最终视力结果显著相关。这种新的分级系统为评估SJS患者提供了一种更客观的方法，可能适用于其他瘢痕性眼表疾病。
