title: New grading system for the evaluation of chronic ocular manifestations in patients with Stevens-Johnson syndrome.
abstract: OBJECTIVE
  To evaluate and grade the extent and severity of chronic ocular manifestations in Stevens-Johnson syndrome (SJS).
  
  
  METHODS
  Prospective multicenter case series.
  
  
  METHODS
  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.
  
  
  METHODS
  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 may be adapted for use in other cicatricial ocular surface diseases.
authors.affiliation: Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan. csotozon@ophth.kpu-m.ac.jp
authors.forename: Chie
authors.initials: C
authors.lastname: Sotozono
authors.forename: Leonard P K
authors.initials: LP
authors.lastname: Ang
authors.forename: Noriko
authors.initials: N
authors.lastname: Koizumi
authors.forename: Hisayo
authors.initials: H
authors.lastname: Higashihara
authors.forename: Mayumi
authors.initials: M
authors.lastname: Ueta
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Inatomi
authors.forename: Norihiko
authors.initials: N
authors.lastname: Yokoi
authors.forename: Minako
authors.initials: M
authors.lastname: Kaido
authors.forename: Murat
authors.initials: M
authors.lastname: Dogru
authors.forename: Jun
authors.initials: J
authors.lastname: Shimazaki
authors.forename: Kazuo
authors.initials: K
authors.lastname: Tsubota
authors.forename: Masakazu
authors.initials: M
authors.lastname: Yamada
authors.forename: Shigeru
authors.initials: S
authors.lastname: Kinoshita
mesh_terms: D000328:Adult; D000368:Aged; D002386:Cataract / Q000175:diagnosis / Q000209:etiology; D002908:Chronic Disease; D003229:Conjunctival Diseases / Q000175:diagnosis / Q000209:etiology; D003316:Corneal Diseases / Q000175:diagnosis / Q000209:etiology; D003941:Diagnostic Techniques, Ophthalmological; D005128:Eye Diseases / Q000175:diagnosis* / Q000209:etiology* / Q000503:physiopathology; D005141:Eyelid Diseases / Q000175:diagnosis / Q000209:etiology; D005260:Female; D005901:Glaucoma / Q000175:diagnosis / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012044:Regression Analysis; D012720:Severity of Illness Index; D013262:Stevens-Johnson Syndrome / Q000150:complications*; D014786:Vision Disorders / Q000209:etiology; D014792:Visual Acuity