A recent study compared long-term visual outcomes of various management strategies for Stevens-Johnson syndrome (SJS) and found a two-pronged approach may provide patients the best chance of long-term preservation of vision.

Researchers looked at 705 eyes (81 children and 320 adults) with SJS who presented with chronic lid-related keratopathy between 1990 and 2015, all of whom had comparable best-corrected visual acuity (BCVA) at baseline. Eyes received either conservative therapy or definitive management, including mucous membrane grafting, the Prosthetic Replacement of the Ocular Surface Ecosystem (PROSE) scleral contact lens, or both.

Those who received conservative therapy lost at least five lines of vision over a period of 10 years and had three times higher risk of developing corneal ulceration in the first year. Those who received definitive therapy saw an improvement in median BCVA. Mucous membrane grafting was more effective in children than PROSE, while PROSE was more effective than mucous membrane grafting in adults. A combination of grafting and PROSE yielded the best results in both children and adults.

The study authors concluded that mucous membrane grafting and PROSE changed the natural course of SJS and provided best long-term visual outcomes.

Shanbhag S, Singh M, Bahuguna C, et al. Lid-related keratopathy in Stevens-Johnson Syndrome: Natural course and impact of therapeutic interventions in children and adults. Am J Ophthalmology. July 15, 2020. [Epub ahead of print].