Ma David Hui-Kang, Tsai Tsung-Ying, Pan Li-Yen, Chen Shin-Yi, Hsiao Ching-Hsi, Yeh Lung-Kun, Tan Hsin-Yuan, Lu Chun-Wei, Chen Chun-Bing, Chung Wen-Hung
Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
Department of Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
Front Med (Lausanne). 2021 May 12;8:661891. doi: 10.3389/fmed.2021.661891. eCollection 2021.
Over the last decade, there has been tremendous progress in the treatment of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). To understand whether this has resulted in better ophthalmic outcomes, we aimed to study the incidence of severe ocular complications (SOCs) in the acute and chronic stage among SJS/TEN patients, major causative medications, and therapeutic effect of medical and surgical treatment. Using electronic medical records review of patients of Chang Gung Memorial Hospital Linkou Branch from 2010 to 2020, 119 patients (236 eyes) received ophthalmic consultation during the acute stage and were retrospectively studied. Sotozono's grading score systems for acute and chronic SJS/TEN were employed for accessing correlation between acute and chronic presentations, the therapeutic effect of systemic etanercept treatment, and outcome of early amniotic membrane transplantation (AMT) performed in patients with severe acute SOCs. There were 46 male and 73 female patients with a mean age of 45.6 ± 22.7 years old (2-90 years), and follow-up time of 408.3 ± 351.0 (116-1,336) days. The numbers of patients with SJS, overlap syndrome, and TEN were 87, 9, and 23, respectively. In total, 109 eyes (55 patients) had acute SOCs, which comprised 46.2% of patients who underwent ophthalmic examination. Antiepileptics were the most common category of culprit drugs causing SOCs in the acute stage. At the end of follow-up, there were 14 eyes (9 patients) with chronic SOCs (5.9%), and non-steroidal anti-inflammatory drugs and cold medicine were the most common causative medications that were associated with severe chronic sequela. The correlation between Sotozono's acute and chronic grading score showed a positive relationship [Spearman's rank correlation coefficient () = 0.52, < 0.001]. The average chronic grading scores in patients receiving systemic corticosteroid combined with etanercept treatment were significantly lower than those receiving corticosteroid only, Finally, the average chronic grading scores in patients receiving AMT <7 days after onset were significantly lower than those performed beyond 7 days. Our study implies that acute manifestation can be an indicator for chronic sequelae. Additional early etanercept treatment and early AMT showed beneficial effect in reducing chronic ocular sequela.
在过去十年中，史蒂文斯-约翰逊综合征（SJS）和中毒性表皮坏死松解症（TEN）的治疗取得了巨大进展。为了解这是否带来了更好的眼科治疗效果，我们旨在研究SJS/TEN患者在急性期和慢性期严重眼部并发症（SOCs）的发生率、主要致病药物以及药物和手术治疗的效果。通过回顾2010年至2020年长庚纪念医院林口院区患者的电子病历，对119例患者（236只眼）在急性期接受眼科会诊的情况进行了回顾性研究。采用Sotozono的急性和慢性SJS/TEN分级评分系统来评估急性和慢性表现之间的相关性、全身性依那西普治疗的效果以及在严重急性SOCs患者中早期羊膜移植（AMT）的结果。有46例男性和73例女性患者，平均年龄为45.6±22.7岁（2至90岁），随访时间为408.3±351.0（116至1336）天。SJS、重叠综合征和TEN患者的数量分别为87例、9例和23例。共有109只眼（55例患者）出现急性SOCs，占接受眼科检查患者的46.2%。抗癫痫药物是急性期导致SOCs最常见的罪魁祸首药物类别。在随访结束时，有14只眼（9例患者）出现慢性SOCs（5.9%），非甾体抗炎药和感冒药是与严重慢性后遗症相关最常见的致病药物。Sotozono急性和慢性分级评分之间的相关性呈正相关[斯皮尔曼等级相关系数（）=0.52，<0.001]。接受全身性皮质类固醇联合依那西普治疗的患者的平均慢性分级评分显著低于仅接受皮质类固醇治疗的患者。最后，发病后<7天接受AMT的患者的平均慢性分级评分显著低于发病后超过7天进行AMT的患者。我们的研究表明急性表现可作为慢性后遗症的一个指标。额外的早期依那西普治疗和早期AMT在减少慢性眼部后遗症方面显示出有益效果。
