Treatment May Restore Vision Of Those Blinded By Stevens-Johnson Syndrome
A new study suggests that a new treatment may be able to restore vision to those who are blinded by Stevens-Johnson yndrome (SJS).
The study investigated a procedure known as cultivated oral mucosal epithelial transplantation (COMET), evaluating 45 eyes of 41 patients suffering from chronic SJS sequelae. All patients underwent COMET and their change in corrected distance visual acuity, severity scores of various ocular surface parameters and occurrence of complications were documented over a period of two years. The primary outcome measure was attainment and maintenance of a stable ocular surface, as assessed by change in the ocular surface severity scores. The secondary outcome measure was change in corrected distance visual acuity.
The study concluded that “COMET allows successful and sustained restoration of ocular surface anatomy with functional improvement, in eyes with chronic sequelae of SJS.”
The study found that 82.2% of eyes had an improvement in visual acuity. 13.3% of the eyes saw no change while two eyes got worse. Two eyes in the study developed persistent epithelial defects, progressing to corneal melting requiring keratoplasty.
SJS is a severe skin reaction. Especially severe SJS is known as toxic epidermal necrolysis (TEN). SJS starts out with fever and flu-like symptoms them progresses into peeling, blistering skin, typically involving mucous membranes. Multiple organ failure, pneumonia, sepsis and dehydration can result.
The primary cause of SJS is medications. SJS occurs when a drug stimulates cytotoxic T cells and T helper cells, initiating autoimmune reactions which attack a person’s tissues. Over 100 drugs may be associated with SJS. SJS can be caused by antibiotics, especially sulfa drugs.
SJS may be caused by rivaroxaban, vancomycin, allopurinol, valproate, levofloxacin, diclofenac, etravirine, isotretinoin, fluconazole, valdecoxib, sitagliptin, oseltamivir, penicillins, barbiturates, sulfonamides, phenytoin, azithromycin, oxcarbazepine, zonisamide, modafinil, lamotrigine, nevirapine, pyrimethamine, ibuprofen, ethosuximide, carbamazepine, bupropion, telaprevir, and nystatin.
Sulfonamide antibiotics, cefixime, penicillin, lamotrigine, barbituates, phenytoin and trimethoprim have been traditionally known to lead to SJS.
Nonsteroidal anti-inflammatory drugs are a cause of SJS, as is acetaminophen.
Some commonly known drugs which may be linked to SJS include Advil, Children’s Motrin, Nexium, Prevacid, Prilosec, Tylenol and Zithromax.
The mortality rate for SJS is around 5 percent and the mortality rate for TEN is 30 to 40 percent. The prognosis for SJS and TEN patients is better the earlier the causative medication is withdrawn.
Around 300 new diagnoses of SJS are made each year in the United States. SJS is more common in adults than in children.