Multi-Step Grading System for Evaluation of Chronic Ocular Sequelae in Patients with Stevens-Johnson Syndrome.

Abstract

PURPOSE\nTo propose a new scoring system for grading of chronic ocular sequelae in Stevens-Johnson syndrome (SJS).\n\n\nDESIGN\nReliability and validity analysis PARTICIPANTS: Four hundred eyes of 200 patients with chronic ocular SJS/TEN were included in the study.\n\n\nSETTINGS\nSingle centre, tertiary eye care referral centre METHODS: All patients of SJS/TEN with chronic (more than one year) ocular sequelae were recruited for the study. Corneal, eyelid and conjunctival signs were evaluated and given scores ranging from 0 to 5 depending on the increasing severity. Twelve signs (6 corneal, 3 conjunctival and 3 eyelid) were evaluated to obtain the total severity score for each eye. Based on the corrected distance visual acuity (CDVA) and total score, each eye was graded using receiver operating characteristic (ROC) analysis.\n\n\nMAIN OUTCOME MEASURES\nCorrelation of CDVA with the severity score determined on the basis of 12 corneal, eye lid and conjunctival signs.\n\n\nRESULTS\nThe study included 400 eyes of 200 patients. Mean age was 24.09 ± 10.9 years. The most common inciting agent for SJS was oral medications (85%). The scores of 12 ocular surface parameters correlated significantly with CDVA (p<0.001). ROC analysis revealed four grades of total severity score of 0 to 11(Stage 0), 12 to 16 (Stage 1), 17 to 22 (Stage 2) and 23 to 53 (Stage 3). The total severity score correlated significantly with logMAR visual acuity grades with an agreement of 60.7% using Cohen s kappa analysis (Kappa coefficient= 0.420 ± 0.03). The most common stage of total severity score SJS eye was Stage 3 in 49% eyes(196/400) eyes followed by Stage 0 (107/400, 26.7%).\n\n\nCONCLUSIONS\nThe multi-step scoring system of chronic ocular features in SJS/TEN sequelae is a useful tool to grade all levels of severity. This may help to evaluate the efficacy of the surgical intervention by comparing preoperative with postoperative ocular grades.