Clinical Analysis Of Acute Phase Of Stevens-Johnson Syndrome And Toxic Epidermal Necrolysis And Chronic Microsome Confocal Microscopy

Part â…  Clinical analysis of patients with acute Stevens-Johnson syndrome and toxic epidermal necrolysisObjective To analyze the clinical characteristics of the ocular symptoms and treatments for Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) induced by drug eruption during the acute stage.Methods A retrospective analysis was undertaken of all patients admitted from May 2012 to April 2015 in Peking Union Medical College Hospital with a diagnosis of SJS or TEN.Results A total of 26 patients (13 male,13 female) with SJS or TEN were consecutively recruited. In the 26 patients, antibiotics (8 patients,30.8%), antipyretic analgesics (6 patients,23.1%) and antipsychotics (5 patients,19.2%) were the main drugs causing Stevens-Johnson syndrome and toxic epidermal necrolysis. Ocular involvements was noted in 18 patients (36 eyes,69.2%). Of the 18 patients with ocular involvements,100% had bilateral lesions. Conjunctival hyperaemia, conjunctival exudation and eyelid lesion were noted in 15 patients (30 eyes,83.3%),13 patients (26 eyes,72.2%) and 10 patients (20 eyes,55.6%), respectively. Lid margin lesion, conjunctival pseudomembrane, and corneal erosion were noted in 8 patients (16 eyes,44.4%),7 patients (14 eyes,38.9%) and 3 patients (6 eyes,16.7%), respectively. Systemic corticosteriod was administered in all cases. Ophthalmic treatments were also used on patients with ocular involvements, including corticosteriod eyedrops, cyclosporin eyedrops, artificial tears or separation of symblepharon. Treatments were based on the severity of the ocular symptoms.Conclusions SJS and TEN exhibit variable degrees of skin and mucous membrane damage within the acute stage, commonly accompanied with ocular involvements. Sufficient systemic and local corticosteriods are essential to control disease progression and reduce ocular complications.Part â…¡ In vivo confocal microscopic observation of corneal changes in chronic Stevens-Johnson syndrome and toxic epidermal necrolysisObjective To describe corneal alterations visible on in vivo confocal microscopy, in patients with debilitating ocular sequelae causing by Stevens-Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN).Methods Twenty-two eyes of 11 consecutive patients suffering from chronic SJS or TEN were studied using slit lamp and in vivo confocal microscopy in the ophthalmology outpatient of Peking Union Medical College Hospital from March 2014 to April 2015.Results Dry eye with meibomian gland dysfunction (19 eyes,10 patients,86.4%) was the most frequent clinical sequelae. Two patients (3 eyes,13.6%) had severe vison loss with corneal neovascularization and conjunctivization. One patient had asymmetric binocular disease. Corneal epithelial cells were observed at an active state in 10 patients (19 eyes,86.4%) and corneal strmal cells at an active state in all patients (22 eyes,100%). 20 eyes (10 patients,91%) were noted with abnormal nerve layout and 10 eyes (5 patients,45.5%) with dendriticform cell infiltration around pathological nerve damages. Numerors inflammory cells were observed in 6 eyes (3 patients,27.3%).Conclusions The corneas of patients with chronic ocular sequelae associated with SJS and TEN present a number of abnormalities. In vivo confocal microscopy is a potetial useful tool for therapeutic indications and for follow-up of the debilitating chronic ocular problems linked to SJS and TEN.