title: Predictive Factors Associated With Acute Ocular Involvement in Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis.
abstract: OBJECTIVE
  To suggest an objective score for grading the acute ocular severity of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), and to determine predictive factors for severe acute ocular involvement such as ocular surface epithelial defect and/or pseudomembrane formation.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  The medical records of SJS (n = 87) and TEN (n = 48) patients between 2005 and 2007 were reviewed. An acute ocular severity score was determined on a scale from 0 to 3 (none, mild, severe, and very severe) according to the existence of hyperemia, corneal or conjunctival epithelial defect, and pseudomembrane formation. The associations between the severe acute ocular involvement and factors such as patient age, exposed drugs, systemic severity, and the prevalence of ocular sequelae were examined.
  
  
  RESULTS
  The number of cases with score grade 0, 1, 2, and 3 was 19 (21.8%), 31 (35.6%), 22 (25.3%), and 15 (17.2%) in 87 SJS cases and 12 (25.0%), 11 (22.9%), 17 (35.4%), and 8 (16.7%) in 48 TEN cases. Multivariate logistic regression analysis revealed that patient age (odds ratio [OR], 0.98; 95% confidence interval [CI], 0.96-0.99; P = .007) and nonsteroidal anti-inflammatory drugs NSAIDs or cold remedies (OR, 2.58; 95% CI, 1.26-5.29; P = .010) were predictive factors for severe acute ocular involvement. The prevalence of visual disturbance and eye dryness increased according to the increase of acute ocular severity (P = .001 and P = .007 in SJS; P = .007 and P = .014 in TEN, respectively).
  
  
  CONCLUSIONS
  At the onset of SJS/TEN, strict attention should be paid to ocular involvement in young patients and in patients exposed to NSAIDs or cold remedies.
authors.affiliation: Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan. Electronic address: csotozon@koto.kpu-m.ac.jp.
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: Translational Research Informatics Center, Foundation for Biomedical Research and Innovation, Kobe, Japan.
authors.forename: Eiji
authors.initials: E
authors.lastname: Nakatani
authors.affiliation: Department of Dermatology, Showa University School of Medicine, Tokyo, Japan.
authors.forename: Amane
authors.initials: A
authors.lastname: Kitami
authors.affiliation: Department of Dermatology, Showa University School of Medicine, Tokyo, Japan.
authors.forename: Hideaki
authors.initials: H
authors.lastname: Watanabe
authors.affiliation: Department of Dermatology, Showa University School of Medicine, Tokyo, Japan.
authors.forename: Hirohiko
authors.initials: H
authors.lastname: Sueki
authors.affiliation: Department of Dermatology, Showa University School of Medicine, Tokyo, Japan.
authors.forename: Masafumi
authors.initials: M
authors.lastname: Iijima
authors.affiliation: Department of Dermatology, Yokohama City University Medical Center, Yokohama, Japan.
authors.forename: Michiko
authors.initials: M
authors.lastname: Aihara
authors.affiliation: Department of Dermatology, Yokohama City University Medical Center, Yokohama, Japan.
authors.forename: Zenro
authors.initials: Z
authors.lastname: Ikezawa
authors.affiliation: Department of Pediatrics, Yokohama City University Medical Center, Yokohama, Japan.
authors.forename: Yukoh
authors.initials: Y
authors.lastname: Aihara
authors.affiliation: Department of Dermatology, Kyorin University School of Medicine, Tokyo, Japan.
authors.forename: Yoko
authors.initials: Y
authors.lastname: Kano
authors.affiliation: Department of Dermatology, Kyorin University School of Medicine, Tokyo, Japan.
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Shiohara
authors.affiliation: Department of Dermatology, Ehime University Graduate School of Medicine, Matsuyama, Japan.
authors.forename: Mikiko
authors.initials: M
authors.lastname: Tohyama
authors.affiliation: Department of Dermatology, Ehime University Graduate School of Medicine, Matsuyama, Japan.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Shirakata
authors.affiliation: Translational Research Informatics Center, Foundation for Biomedical Research and Innovation, Kobe, Japan.
authors.forename: Hideaki
authors.initials: H
authors.lastname: Kaneda
authors.affiliation: Translational Research Informatics Center, Foundation for Biomedical Research and Innovation, Kobe, Japan.
authors.forename: Masanori
authors.initials: M
authors.lastname: Fukushima
authors.affiliation: Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan.
authors.forename: Shigeru
authors.initials: S
authors.lastname: Kinoshita
authors.affiliation: Department of Dermatology, Ehime University Graduate School of Medicine, Matsuyama, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Hashimoto
mesh_terms: D000208:Acute Disease; D003228:Conjunctiva / Q000473:pathology*; D003315:Cornea / Q000473:pathology*; D005128:Eye Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012590:Sclera / Q000473:pathology*; D013262:Stevens-Johnson Syndrome / Q000150:complications* / Q000175:diagnosis