New grading system for the evaluation of chronic ocular manifestations in patients with Stevens-Johnson syndrome
New grading system for the evaluation of chronic ocular manifestations in patients with Stevens-Johnson syndrome
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DOI：
10.1016/j.ophtha.2006.10.029
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发表时间：
2007-07-01
期刊：
影响因子：
13.7
通讯作者：
Kinoshita, Shigeru
中科院分区：
文献类型：
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作者：
Sotozono, Chie;Ang, Leonard P. K.;Kinoshita, Shigeru
目的：评价和分级Stevens-Johnson综合征（SJS）的慢性眼部表现的范围和严重程度。设计：前瞻性多中心病例系列。参与者：我们纳入了73例患者2003年4月至2005年3月在3个三级转诊中心就诊的138只眼SJS患者。纳入了有确诊的SJS病史和自SJS发作后持续至少1年的慢性眼部并发症的患者。他们的详细病史和眼科检查结果记录在逐项数据收集表上。并发症分为角膜、结膜和眼睑并发症，共13种并发症，并根据其严重程度按0 ~ 3级进行评分。主要结果指标：这些被广泛归类为角膜（浅表点状角膜病变、上皮缺损、沃格特栅栏丧失、结膜化、新生血管形成、浑浊化、角化）、结膜结果：最严重的并发症是沃格特栅栏丧失（114眼; 82.6%）和睑板腺受累（102眼; 73.9%）。138只眼中74只眼（53.6%）视力低于20/200。角膜、结膜和眼睑并发症的严重程度与视力丧失显著相关。13例并发症均与最小分辨角（logMAR）视力的对数显著相关，相关系数（R）为0.359 ~ 0.810（P < 0.0001），角膜上皮缺损的相关系数（R）为0.169（P = 0.0473）。3种并发症总评分较高的患眼视力较差（R = 0.806; P < 0.0001）。多因素回归分析显示角膜新生血管、混浊、角化和白内障显著影响logMAR视力（P < 0.0001，P < 0.0001，P = 0.0142，P = 0.0375）。作者描述了一种对SJS患者眼部受累的范围和严重程度进行分级的新方法，并证明了SJS患者眼部受累的严重程度眼部受累与最终视力结果显著相关。这种新的分级系统为SJS患者提供了一种更客观的评估方法，并可能适用于其他瘢痕性眼表疾病。
Purpose: To evaluate and grade the extent and severity of chronic ocular manifestations in Stevens-Johnson syndrome (SJS).Design: Prospective multicenter case series.Participants: We enrolled 73 patients (138 eyes) with SJS seen between April 2003 and March 2005 at 3 tertiary referral centers.Methods: Patients with a confirmed history of SJS and chronic ocular complications that persisted for at least 1 year from the onset of SJS were included. Their detailed medical history and ophthalmic examination results were recorded on an itemized data collection form. Complications were categorized as corneal, conjunctival, and eyelid complications, and 13 components were evaluated and graded on a scale from 0 to 3 according to their severity.Main Outcome Measures: These were broadly classified as corneal (superficial punctate keratopathy, epithelial defect, loss of the palisades of Vogt, conjunctivalization, neovascularization, opacification, keratinization), conjunctival (hyperemia, symblepharon formation), and eyelid (trichiasis, mucocutaneous junction involvement, meibomian gland involvement, punctal damage) complications.Results: The most severely affected complication components were loss of the palisades of Vogt (114 eyes; 82.6%) and meibomian gland involvement (102 eyes; 73.9%). Visual acuity in 74 of the 138 eyes (53.6%) was worse than 20/200. The severity of corneal, conjunctival, and eyelid complications was significantly correlated with visual loss. All 13 complications were correlated significantly with logarithm of the minimum angle of resolution (logMAR) visual acuity; the correlation coefficient (R) ranged from 0.359 to 0.810 (P < 0.0001); for corneal epithelial defects, R was 0.169 (P = 0.0473). Eyes with a higher total score for the 3 complication categories had poorer vision (R = 0.806; P < 0.0001). Multivariate regression analysis showed that corneal neovascularization, opacification, keratinization, and cataracts significantly affected logMAR visual acuity (P < 0.0001, P < 0.0001, P = 0.0142, P = 0.0375, respectively).Conclusions: The authors describe a new method for grading the extent and severity of ocular involvement in patients with SJS and demonstrate that the severity of ocular involvement is correlated significantly with the final visual outcome. This new grading system provides a more objective method for evaluating SJS patients and maybe adapted for use in other cicatricial ocular surface diseases.