The role of systemic immunomodulatory treatment and prognostic factors on chronic ocular complications in stevens-johnson syndrome

Dong Hyun Kim, Kyung Chul Yoon, KyoungYul Seo, Hyo Seok Lee, Sang Chul Yoon, Chie Sotozono, Mayumi Ueta, Mee Kum Kim

Research output: Contribution to journalArticle

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Abstract

Purpose To compare the effect of early systemic immunomodulatory treatment and to identify prognostic factors of chronic ocular complications in Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) patients. Design Retrospective, comparative, multicenter study. Participants Forty-three patients admitted to 1 of 3 University Hospitals (Seoul National University Hospital, Chonnam National University Hospital, and Yonsei University Hospital) with a diagnosis of SJS or TEN who were followed up for at least 6 months in Korea. Methods Patients were divided into 5 groups according to systemic immunomodulatory treatment received: systemic steroids (S), intravenous immunoglobulin (IVIG), combined S plus IVIG, systemic pulse steroids (PS), and supportive care only (C). Best-corrected visual acuity (BCVA) and chronic ocular surface complications score (COCS; range, 0-15) at final follow-up were compared among the 5 groups. Prognostic factors at onset (age, gender, causative drugs, initial visual acuities, acute ocular involvement score [range, 0-3], acute systemic involvement score [range, 0-16], systemic steroid dose, IVIG dose, and amniotic membrane transplantation [AMT]) were analyzed to predict final BCVA or COCS using logistic regression or linear regression analysis. Main Outcome Measures Best-corrected visual acuity and COCS at final follow-up. Results The mean age and follow-up period of the patients was 30.5±21.0 years and 29.1±30.4 months, respectively. The acute systemic involvement score in the IVIG, S plus IVIG, and PS groups was significantly higher than that in the S and C groups (P < 0.001). However, final BCVA and COCS were not significantly different between groups, even after statistical adjustment. High COCS (≥8 points) was associated with female gender (P = 0.012) and AMT at the acute stage (P = 0.040). High acute ocular and systemic involvement scores were associated with worse COCS (P < 0.001), and COCS showed good correlation with final BCVA (R2 = 0.7101; P < 0.0001). Conclusions There were no therapeutic benefits of systemic immunomodulatory treatments in final visual outcome and COCS in SJS and TEN patients. Female gender and acute ocular and systemic involvement scores may be prognostic factors predicting chronic ocular complications.

Original languageEnglish
Pages (from-to)254-264
Number of pages11
JournalOphthalmology
Volume122
Issue number2
DOIs
Publication statusPublished - 2015 Jan 1

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Stevens-Johnson Syndrome
Intravenous Immunoglobulins
Visual Acuity
Steroids
Amnion
Therapeutics
Transplantation
Social Adjustment
Korea
Age of Onset
Multicenter Studies
Linear Models
Logistic Models
Regression Analysis
Outcome Assessment (Health Care)
Pharmaceutical Preparations

All Science Journal Classification (ASJC) codes

  • Ophthalmology

Cite this

Kim, Dong Hyun ; Yoon, Kyung Chul ; Seo, KyoungYul ; Lee, Hyo Seok ; Yoon, Sang Chul ; Sotozono, Chie ; Ueta, Mayumi ; Kim, Mee Kum. / The role of systemic immunomodulatory treatment and prognostic factors on chronic ocular complications in stevens-johnson syndrome. In: Ophthalmology. 2015 ; Vol. 122, No. 2. pp. 254-264.
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author = "Kim, {Dong Hyun} and Yoon, {Kyung Chul} and KyoungYul Seo and Lee, {Hyo Seok} and Yoon, {Sang Chul} and Chie Sotozono and Mayumi Ueta and Kim, {Mee Kum}",
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The role of systemic immunomodulatory treatment and prognostic factors on chronic ocular complications in stevens-johnson syndrome. / Kim, Dong Hyun; Yoon, Kyung Chul; Seo, KyoungYul; Lee, Hyo Seok; Yoon, Sang Chul; Sotozono, Chie; Ueta, Mayumi; Kim, Mee Kum.

In: Ophthalmology, Vol. 122, No. 2, 01.01.2015, p. 254-264.

Research output: Contribution to journalArticle

TY - JOUR

T1 - The role of systemic immunomodulatory treatment and prognostic factors on chronic ocular complications in stevens-johnson syndrome

AU - Kim, Dong Hyun

AU - Yoon, Kyung Chul

AU - Seo, KyoungYul

AU - Lee, Hyo Seok

AU - Yoon, Sang Chul

AU - Sotozono, Chie

AU - Ueta, Mayumi

AU - Kim, Mee Kum

PY - 2015/1/1

Y1 - 2015/1/1

N2 - Purpose To compare the effect of early systemic immunomodulatory treatment and to identify prognostic factors of chronic ocular complications in Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) patients. Design Retrospective, comparative, multicenter study. Participants Forty-three patients admitted to 1 of 3 University Hospitals (Seoul National University Hospital, Chonnam National University Hospital, and Yonsei University Hospital) with a diagnosis of SJS or TEN who were followed up for at least 6 months in Korea. Methods Patients were divided into 5 groups according to systemic immunomodulatory treatment received: systemic steroids (S), intravenous immunoglobulin (IVIG), combined S plus IVIG, systemic pulse steroids (PS), and supportive care only (C). Best-corrected visual acuity (BCVA) and chronic ocular surface complications score (COCS; range, 0-15) at final follow-up were compared among the 5 groups. Prognostic factors at onset (age, gender, causative drugs, initial visual acuities, acute ocular involvement score [range, 0-3], acute systemic involvement score [range, 0-16], systemic steroid dose, IVIG dose, and amniotic membrane transplantation [AMT]) were analyzed to predict final BCVA or COCS using logistic regression or linear regression analysis. Main Outcome Measures Best-corrected visual acuity and COCS at final follow-up. Results The mean age and follow-up period of the patients was 30.5±21.0 years and 29.1±30.4 months, respectively. The acute systemic involvement score in the IVIG, S plus IVIG, and PS groups was significantly higher than that in the S and C groups (P < 0.001). However, final BCVA and COCS were not significantly different between groups, even after statistical adjustment. High COCS (≥8 points) was associated with female gender (P = 0.012) and AMT at the acute stage (P = 0.040). High acute ocular and systemic involvement scores were associated with worse COCS (P < 0.001), and COCS showed good correlation with final BCVA (R2 = 0.7101; P < 0.0001). Conclusions There were no therapeutic benefits of systemic immunomodulatory treatments in final visual outcome and COCS in SJS and TEN patients. Female gender and acute ocular and systemic involvement scores may be prognostic factors predicting chronic ocular complications.

AB - Purpose To compare the effect of early systemic immunomodulatory treatment and to identify prognostic factors of chronic ocular complications in Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) patients. Design Retrospective, comparative, multicenter study. Participants Forty-three patients admitted to 1 of 3 University Hospitals (Seoul National University Hospital, Chonnam National University Hospital, and Yonsei University Hospital) with a diagnosis of SJS or TEN who were followed up for at least 6 months in Korea. Methods Patients were divided into 5 groups according to systemic immunomodulatory treatment received: systemic steroids (S), intravenous immunoglobulin (IVIG), combined S plus IVIG, systemic pulse steroids (PS), and supportive care only (C). Best-corrected visual acuity (BCVA) and chronic ocular surface complications score (COCS; range, 0-15) at final follow-up were compared among the 5 groups. Prognostic factors at onset (age, gender, causative drugs, initial visual acuities, acute ocular involvement score [range, 0-3], acute systemic involvement score [range, 0-16], systemic steroid dose, IVIG dose, and amniotic membrane transplantation [AMT]) were analyzed to predict final BCVA or COCS using logistic regression or linear regression analysis. Main Outcome Measures Best-corrected visual acuity and COCS at final follow-up. Results The mean age and follow-up period of the patients was 30.5±21.0 years and 29.1±30.4 months, respectively. The acute systemic involvement score in the IVIG, S plus IVIG, and PS groups was significantly higher than that in the S and C groups (P < 0.001). However, final BCVA and COCS were not significantly different between groups, even after statistical adjustment. High COCS (≥8 points) was associated with female gender (P = 0.012) and AMT at the acute stage (P = 0.040). High acute ocular and systemic involvement scores were associated with worse COCS (P < 0.001), and COCS showed good correlation with final BCVA (R2 = 0.7101; P < 0.0001). Conclusions There were no therapeutic benefits of systemic immunomodulatory treatments in final visual outcome and COCS in SJS and TEN patients. Female gender and acute ocular and systemic involvement scores may be prognostic factors predicting chronic ocular complications.

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