LAUSR

PURPOSE To describe the long-term impact of a treatment protocol for ocular involvement in acute Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN), including focused ocular examination and pathology-appropriate use of lubrication, topical corticosteroids, topical antibiotics, and amniotic membrane transplantation. DESIGN Retrospective, comparative case series METHODS: A total of 48 patients (96 eyes) were included in this study. Nine out of 48 patients (18 eyes) had acute SJS/TEN from 2000 to 2007 and did not receive protocol care (Group I). Thirty nine out of 48 patients (78 eyes) had acute SJS/TEN from 2008 to 2017 and received protocol care (Group II). The main outcome measures were best-corrected visual acuity (BCVA) at final follow-up visit and incidence of complications in the chronic phase. RESULTS No eyes in Group I received amniotic membrane transplantation (AMT) for SJS/TEN, compared to 87% of qualifying eyes in Group II (p<0.0001) There was a significant difference in the proportion of eyes with BCVA ≥ 20/40 at last follow-up between Group I and Group II, [33% vs 92%, p<0.001]. The proportion of eyes with vision-threatening complications in the chronic phase was significantly higher in Group I versus Group II (67% vs 17%, p=0.002), with most complications occurring in the first two years after disease onset in both groups. CONCLUSIONS A specific protocol for acute ocular care in SJS/TEN, including aggressive use of amniotic membrane transplantation, was highly successful in reducing corneal blindness and severe vision-threatening complications of the disorder.