Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.
Department of Anatomy, All India Institute of Medical Sciences, New Delhi, India.
Cornea. 2019 Aug;38(8):938-942. doi: 10.1097/ICO.0000000000001960.
To evaluate the microbiological profile and outcome in cases with infective keratitis in Stevens-Johnson syndrome (SJS).
Eighty-three eyes of 68 patients with SJS presenting with microbial keratitis were recruited and managed with standard antimicrobial therapy.
Microbial keratitis developed in 34% of patients with SJS (83 eyes, 68 patients) over a period of 5 years. Four eyes (4.8%) had a history of concurrent topical steroid use at the onset of keratitis. Mean baseline best-corrected visual acuity was 1.8 ± 0.9 logMAR units. The site of corneal ulceration was central in 52 eyes (62.6%), paracentral in 17 eyes (20.5%), and peripheral in 14 eyes (16.8%). The mean ulcer area was 3.9 ± 2.7 mm. Approximately 15 of 24 (62.5%) culture-positive eyes had bacterial infection, most of which (80%) were caused by Gram-positive bacteria. Polymicrobial infection was noted in 7 of 24 eyes (29.1%). Although 57 of 83 (68.6%) eyes healed with medical therapy, 26 of 83 (31.3%) eyes had corneal perforation and were managed with cyanoacrylate glue application (30.7%) or therapeutic keratoplasty (69.3%). Systemic infection as an inciting factor of SJS and an early presentation for keratitis were the major risk factors associated with corneal perforation. Large mean ulcer size, paracentral ulcers, and punctal involvement were associated with a good visual outcome.
Infective keratitis in SJS is common, and unlike routine cases, surgical intervention is often required. However, the antibiotic sensitivity pattern suggests that resistance is not that high.
评估史蒂文斯-约翰逊综合征（SJS）患者感染性角膜炎的微生物谱和结局。
共纳入 68 例 SJS 合并微生物角膜炎患者的 83 只眼，均接受标准抗菌治疗。
SJS 患者在 5 年内发生微生物角膜炎的比例为 34%（83 只眼，68 例患者）。4 只眼（4.8%）在角膜炎发病时同时使用局部皮质类固醇。基线时最佳矫正视力的平均对数视力为 1.8±0.9 logMAR 单位。52 只眼（62.6%）的角膜溃疡位于中央，17 只眼（20.5%）位于旁中央，14 只眼（16.8%）位于周边。平均溃疡面积为 3.9±2.7mm。24 只培养阳性眼中有 15 只（62.5%）存在细菌感染，其中大多数（80%）由革兰阳性菌引起。7 只眼（29.1%）存在混合感染。83 只眼中，57 只（68.6%）经药物治疗后愈合，但 26 只眼（31.3%）发生角膜穿孔，其中 30.7%应用氰基丙烯酸酯胶治疗，69.3%行治疗性角膜移植术。SJS 中系统性感染作为激发因素和角膜炎的早期表现是与角膜穿孔相关的主要危险因素。大的平均溃疡大小、旁中央溃疡和泪点受累与良好的视力结局相关。
SJS 合并感染性角膜炎很常见，与常规病例不同，常需要手术干预。然而，抗生素药敏模式表明耐药率并不高。
