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. 2019 Jul;203:69-77. doi: 10.1016/j.ajo.2019.01.028. Epub 2019 Feb 4.
To propose a new scoring system for grading of chronic ocular sequelae in Stevens-Johnson syndrome (SJS).
Reliability and validity analysis.
Participants: Four hundred eyes of 200 patients with chronic ocular SJS/toxic epidermal necrolysis (TEN) were included in the study.
Single-center, tertiary eye care referral center.
All patients with SJS/TEN with chronic (more than 1 year) ocular sequelae were recruited for the study. Corneal, eyelid, and conjunctival signs were evaluated and given scores ranging from 0 to 5 depending on the increasing severity. Twelve signs (6 corneal, 3 conjunctival, and 3 eyelid) were evaluated to obtain the total severity score for each eye. Based on the corrected distance visual acuity (CDVA) and total score, each eye was graded using receiver operating characteristic (ROC) analysis.
Correlation of CDVA with the severity score determined on the basis of 12 corneal, eyelid, and conjunctival signs.
Mean age was 24.09 ± 10.9 years. The most common inciting agent for SJS was oral medications (85%). The scores of 12 ocular surface parameters correlated significantly with CDVA (P < .001). ROC analysis revealed 4 grades of total severity score of 0-11 (stage 0), 12-16 (stage 1), 17-22 (stage 2), and 23-53 (stage 3). The total severity score correlated significantly with logMAR visual acuity grades with an agreement of 60.7% using Cohen's kappa analysis (kappa coefficient = 0.420 ± 0.03). The most common stage of total severity score was stage 3 in 49% of eyes (196/400), followed by stage 0 (107/400, 26.7%).
The multistep scoring system of chronic ocular features in SJS/TEN sequelae is a useful tool to grade all levels of severity. This may help to evaluate the efficacy of the surgical intervention by comparing preoperative with postoperative ocular grades.
提出一种新的史蒂文斯-约翰逊综合征（SJS）慢性眼部后遗症分级评分系统。
可靠性和有效性分析。
参与者：本研究纳入了 200 名慢性 SJS/中毒性表皮坏死松解症（TEN）眼部患者的 400 只眼。
单中心，三级眼科转诊中心。
所有 SJS/TEN 慢性（>1 年）眼部后遗症患者均被招募入组。评估角膜、眼睑和结膜体征，并根据严重程度从 0 到 5 分进行评分。评估 12 个体征（6 个角膜、3 个结膜和 3 个眼睑）以获得每只眼的总严重程度评分。根据矫正视力（CDVA）和总评分，使用接收者操作特征（ROC）分析对每只眼进行分级。
CDVA 与基于 12 个角膜、眼睑和结膜体征确定的严重程度评分的相关性。
平均年龄为 24.09 ± 10.9 岁。SJS 最常见的诱发药物是口服药物（85%）。12 个眼表参数的评分与 CDVA 显著相关（P<.001）。ROC 分析显示，总严重程度评分为 0-11（0 期）、12-16（1 期）、17-22（2 期）和 23-53（3 期），共 4 个等级。总严重程度评分与 logMAR 视力分级显著相关，采用 Cohen's kappa 分析的一致性为 60.7%（kappa 系数=0.420±0.03）。总严重程度评分最常见的阶段是 3 期，占 49%（196/400），其次是 0 期（107/400，26.7%）。
SJS/TEN 后遗症慢性眼部特征的多步评分系统是一种分级所有严重程度的有用工具。这可能有助于通过比较术前和术后眼部分级来评估手术干预的效果。
