Corneal Ectasia in Stevens-Johnson Syndrome: A Sequela of Chronic Disease

Abstract

To describe corneal ectasia in cases of chronic Stevens-Johnson syndrome (SJS). Prospective observational study. Setting: Institutional. Fifteen consecutive cases of chronic SJS. Best-corrected distance visual acuity (BCDVA), maximum corneal curvature (Kmax), anterior elevation, posterior elevation, thinnest pachymetry, and Sotozono severity score. Thirty eyes of 15 patients were included. Corneal tomography using Scheimpflug technology (Pentacam-HR, Oculus GmbH) was performed. Nine eyes were excluded owing to poor-quality scans. The median age was 26 years. The median time from onset of disease to assessment for corneal ectasia was 7 years. The median BCDVA was 0.8 logMAR units at presentation. The median Sotozono severity score was 11. Corneal ectasia (Kmax > 48 diopters [D]) was noted in 76.2% of eyes. The mean Kmax was 58.37 ± 14.89 D. On Belin/Ambrosio enhanced ectasia display the median front and back elevation was 42μm (10-176μm) and 267μm (15-2392μm), respectively. The mean pachymetry was 377.76 ± 165.05μm (133-448μm). The point of maximum ectasia was peripheral in 57.1%, both central and peripheral in19.1%, and central in 23.8% of eyes. On Spearmancorrelation analysis, deterioration in BCDVA (R= 0.759, P < .001) and increase in Kmax (R= 0.589, P= .005) was associated with higher disease severity (Sotozono grading). Corneal ectasia is a common but often missed entity in cases of chronic SJS that may be a cause for poor visual acuity in these cases. All cases of SJS must be evaluated for corneal ectasia, especially when the visual acuity is disproportionate to the disease severity.