title: Treatment Modalities and Clinical Outcomes in Ocular Sequelae of Stevens-Johnson Syndrome Over 25 Years--A Paradigm Shift.
abstract: OBJECTIVE
  To highlight and compare the outcomes of management for the ocular sequelae of Stevens-Johnson syndrome (SJS) over 25 years in a tertiary eye care institute.
  
  
  METHODS
  A retrospective chart review of 798 eyes of 399 patients with SJS evaluated between January 1990 and December 2004 (group I) and of 847 eyes of 517 patients between January 2005 and December 2014 (group II) was done. The primary and secondary outcome measures were a change in the best-corrected visual acuity (BCVA) and an improvement in the symptoms and the ocular surface status, respectively. The groups were subdivided into procedures for ocular surface stabilization (A) and visual rehabilitation (B) and those managed conservatively (C).
  
  
  RESULTS
  In the subgroup A of group II, an improvement/stabilization of BCVA after punctal cautery (231 eyes), mucous membrane grafting for lid margin keratinization (393 eyes), and fornix reconstruction (28 eyes) was noted in 93.6% of eyes. In subgroup B, all 10 eyes that underwent limbal allograft in group I failed when compared with an improvement of BCVA to better than 20/200 in 65.5% of the 61 eyes that underwent keratoprostheses. It was noted that the limbal status worsened in 66.9% of eyes treated conservatively in group I.
  
  
  CONCLUSIONS
  Stabilization procedures show a beneficial role while conservative management can lead to deterioration in chronic ocular sequelae of SJS. Keratoprosthesis, specifically the modified osteo-odonto-keratoprosthesis, forms the mainstay for visual rehabilitation in the end-stage disease. This study highlights the improved outcomes with a paradigm shift in the management modalities.
authors.affiliation: CJ Shah Cornea Services, Dr. G. Sitalakshmi Memorial Clinic for Ocular Surface Disorders, Medical Research Foundation, Sankara Nethralaya, Chennai, India.
authors.forename: Geetha
authors.initials: G
authors.lastname: Iyer
authors.forename: Bhaskar
authors.initials: B
authors.lastname: Srinivasan
authors.forename: Shweta
authors.initials: S
authors.lastname: Agarwal
authors.forename: Vinay S
authors.initials: VS
authors.lastname: Pillai
authors.forename: Ashish
authors.initials: A
authors.lastname: Ahuja
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001187:Artificial Organs; D002648:Child; D002675:Child, Preschool; D003315:Cornea / Q000473:pathology / Q000601:surgery*; D003316:Corneal Diseases / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006801:Humans; D008297:Male; D008875:Middle Aged; D019736:Prostheses and Implants; D012189:Retrospective Studies; D013262:Stevens-Johnson Syndrome / Q000150:complications*; D016896:Treatment Outcome; D014792:Visual Acuity; D055815:Young Adult