Department of Ophthalmology, Osaka Medical College, Takatsuki-City, Osaka, Japan.
Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Cornea. 2020 Jun;39(6):745-753. doi: 10.1097/ICO.0000000000002263.
To investigate the details of the long-term progression of ocular surface cicatrization in eyes with ocular sequelae caused by Stevens-Johnson syndrome (SJS)/toxic epidermal necrosis (TEN).
In 105 eyes of 66 patients with SJS/TEN, the severity of ocular sequelae was retrospectively evaluated using an ocular surface grading score (OSGS) at 2 time points separated by a greater than 5-year interval. The OSGS included 7 ocular surface components (conjunctivalization, neovascularization, opacification, keratinization, symblepharon, and upper/lower conjunctival-sac shortening) evaluated into grades 0 to 3 (maximum total OSGS: 21), with the worsening of each component and total OSGS evaluated at the greater than 5-year interval. Moreover, we evaluated whether upper-tarsus and lid-margin scarring are factors that affect ocular surface cicatrization progression.
In 35 (33.3%) of 105 eyes, the total OSGS worsened during the follow-up period. Partial conjunctivalization (score 1-2) progressed more frequently to total conjunctivalization (score 3) than to no conjunctivalization (score 0) (OR [95% CI]; 5.6 [1.6-20.3]). Partial keratinization (score 1-2) also had a high risk of progression into total keratinization (41.0 [6.3-266.5]). In all cases, keratinization progressed only in the eyes with total conjunctivalization (conjunctivalization score 3). Severity of upper-tarsus scarring or lid-margin scarring affected the worsening of the total OSGS.
In 66 patients with chronic-phase SJS/TEN, ocular surface cicatrization progressed in 33.3% of the 105 eyes during the long-term follow-up period of over 5 years. More than 50% of the partial conjunctivalization eyes progressed toward total conjunctivalization. The partial keratinization eyes had a high possibility of progressing to total keratinization; that is, the so-called "end-stage" status.
探讨史蒂文斯-约翰逊综合征（SJS）/中毒性表皮坏死松解症（TEN）眼部后遗症患者眼表瘢痕长期进展的细节。
回顾性评估了 66 例 SJS/TEN 患者的 105 只眼，使用眼表面分级评分（OSGS）在大于 5 年的时间间隔内评估 2 个时间点的眼部后遗症严重程度。OSGS 包括 7 个眼表面成分（结膜化、新生血管化、混浊、角化、睑球粘连和上/下结膜囊缩短），评分为 0 至 3 级（最大总 OSGS：21），在大于 5 年的间隔时间内评估每个成分和总 OSGS 的恶化情况。此外，我们评估了上睑板和睑缘瘢痕是否是影响眼表瘢痕进展的因素。
在 105 只眼中，有 35 只（33.3%）在随访期间总 OSGS 恶化。部分结膜化（评分 1-2）向完全结膜化（评分 3）进展的频率高于无结膜化（评分 0）（OR [95%CI]；5.6 [1.6-20.3]）。部分角化（评分 1-2）也有向完全角化（41.0 [6.3-266.5]）进展的高风险。在所有病例中，只有在完全结膜化（结膜化评分 3）的眼中，角化才会进展。上睑板瘢痕严重程度或睑缘瘢痕严重程度影响总 OSGS 的恶化。
在 66 例慢性期 SJS/TEN 患者中，在超过 5 年的长期随访期间，105 只眼中有 33.3%的眼表瘢痕出现进展。超过 50%的部分结膜化眼向完全结膜化进展。部分角化眼有向完全角化进展的高可能性，即所谓的“终末期”状态。
