Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.
Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.
Am J Ophthalmol. 2018 Sep;193:1-9. doi: 10.1016/j.ajo.2018.05.030. Epub 2018 Jun 8.
To describe corneal ectasia in cases of chronic Stevens-Johnson syndrome (SJS).
Prospective observational study.
Setting: Institutional.
Fifteen consecutive cases of chronic SJS.
Best-corrected distance visual acuity (BCDVA), maximum corneal curvature (Kmax), anterior elevation, posterior elevation, thinnest pachymetry, and Sotozono severity score.
Thirty eyes of 15 patients were included. Corneal tomography using Scheimpflug technology (Pentacam-HR, Oculus GmbH) was performed. Nine eyes were excluded owing to poor-quality scans. The median age was 26 years. The median time from onset of disease to assessment for corneal ectasia was 7 years. The median BCDVA was 0.8 logMAR units at presentation. The median Sotozono severity score was 11. Corneal ectasia (Kmax > 48 diopters [D]) was noted in 76.2% of eyes. The mean Kmax was 58.37 ± 14.89 D. On Belin/Ambrosio enhanced ectasia display the median front and back elevation was 42 μm (10-176 μm) and 267 μm (15-2392 μm), respectively. The mean pachymetry was 377.76 ± 165.05 μm (133-448 μm). The point of maximum ectasia was peripheral in 57.1%, both central and peripheral in 19.1%, and central in 23.8% of eyes. On Spearman correlation analysis, deterioration in BCDVA (R = 0.759, P < .001) and increase in Kmax (R = 0.589, P = .005) was associated with higher disease severity (Sotozono grading).
Corneal ectasia is a common but often missed entity in cases of chronic SJS that may be a cause for poor visual acuity in these cases. All cases of SJS must be evaluated for corneal ectasia, especially when the visual acuity is disproportionate to the disease severity.
描述慢性史蒂文斯-约翰逊综合征（SJS）病例中的角膜扩张。
前瞻性观察研究。
设置：机构。
15 例连续的慢性 SJS 病例。
最佳矫正远视力（BCVA）、最大角膜曲率（Kmax）、前表面高度、后表面高度、最薄角膜厚度和 Sotozono 严重程度评分。
纳入 15 例患者的 30 只眼。使用 Scheimpflug 技术（Pentacam-HR，Oculus GmbH）进行角膜断层扫描。由于扫描质量差，有 9 只眼被排除在外。中位年龄为 26 岁。从疾病发病到评估角膜扩张的中位时间为 7 年。就诊时的中位 BCVA 为 0.8 对数视力单位。中位 Sotozono 严重程度评分为 11 分。76.2%的眼存在角膜扩张（Kmax＞48 屈光度[D]）。平均 Kmax 为 58.37±14.89 D。在 Belin/Ambrosio 增强型扩张显示中，前表面和后表面高度的中位数分别为 42μm（10-176μm）和 267μm（15-2392μm）。平均角膜厚度为 377.76±165.05μm（133-448μm）。最大扩张点在周边的占 57.1%，在中央和周边的占 19.1%，在中央的占 23.8%。Spearman 相关分析显示，BCVA 恶化（R=0.759，P＜.001）和 Kmax 增加（R=0.589，P=.005）与疾病严重程度（Sotozono 分级）增加相关。
在慢性 SJS 病例中，角膜扩张是一种常见但常被忽视的现象，可能是这些病例视力不佳的原因。所有 SJS 病例都必须评估角膜扩张，尤其是当视力与疾病严重程度不成比例时。
