title: The role of systemic immunomodulatory treatment and prognostic factors on chronic ocular complications in Stevens-Johnson syndrome.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  Retrospective, comparative, multicenter study.
  
  
  METHODS
  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.
  
  
  METHODS
  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 (R(2) = 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.
authors.affiliation: Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea; Laboratory of Ocular Regenerative Medicine and Immunology, Seoul Artificial Eye Center, Seoul National University Hospital Clinical Research Institute, Seoul, Korea.
authors.forename: Dong Hyun
authors.initials: DH
authors.lastname: Kim
authors.affiliation: Department of Ophthalmology, Chonnam National University Medical School, Gwangju, Korea.
authors.forename: Kyung Chul
authors.initials: KC
authors.lastname: Yoon
authors.affiliation: Department of Ophthalmology, Institute of Vision Research, Yonsei University College of Medicine, Seoul, Korea. Electronic address: SEOKY@yuhs.ac.
authors.forename: Kyoung Yul
authors.initials: KY
authors.lastname: Seo
authors.affiliation: Department of Ophthalmology, Chonnam National University Medical School, Gwangju, Korea.
authors.forename: Hyo Seok
authors.initials: HS
authors.lastname: Lee
authors.affiliation: Department of Ophthalmology, Institute of Vision Research, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Sang Chul
authors.initials: SC
authors.lastname: Yoon
authors.affiliation: Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan.
authors.forename: Chie
authors.initials: C
authors.lastname: Sotozono
authors.affiliation: Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan.
authors.forename: Mayumi
authors.initials: M
authors.lastname: Ueta
authors.affiliation: Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea; Laboratory of Ocular Regenerative Medicine and Immunology, Seoul Artificial Eye Center, Seoul National University Hospital Clinical Research Institute, Seoul, Korea. Electronic address: kmk9@snu.ac.kr.
authors.forename: Mee Kum
authors.initials: MK
authors.lastname: Kim
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001684:Biological Dressings; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D003316:Corneal Diseases / Q000188:drug therapy* / Q000503:physiopathology; D004359:Drug Therapy, Combination; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D007155:Immunologic Factors / Q000627:therapeutic use*; D056747:Immunomodulation; D008297:Male; D008875:Middle Aged; D011239:Prednisolone / Q000627:therapeutic use*; D011379:Prognosis; D020551:Pulse Therapy, Drug; D012189:Retrospective Studies; D013262:Stevens-Johnson Syndrome / Q000188:drug therapy* / Q000503:physiopathology; D014792:Visual Acuity / Q000502:physiology
chemical_list: D005938:Glucocorticoids; D016756:Immunoglobulins, Intravenous; D007155:Immunologic Factors; D011239:Prednisolone