Approach to cataract surgery in patients with Stevens-Johnson syndrome

Session Details

Session Title: Cataract Surgery Special Cases

Session Date/Time: Tuesday 25/09/2018 | 08:00-10:00

Paper Time: 09:30

Venue: Room A3, Podium 1

First Author: : S.Agarwal INDIA

Co Author(s): :    B. Srinivasan   G. Iyer                 

Abstract Details

Purpose:

To report outcomes of cataract surgery in patients with chronic sequelae of Stevens Johnsons syndrome (SJS)

Setting:

Sankara Nethralaya, Chennai , India

Methods:

Retrospective interventional analysis of patients with chronic SJS who underwent cataract surgery between January 2005 to January 2018.The data was analysed for demographic data ,precataract surgery vision,ocular surface status and interventions , type of cataract surgery,intraocular lens power (IOL) calculation ,intraoperative complications and post operative vision , ocular surface status and interventions.Primary outcome measure was the change in best corrected visual acuity(BCVA) and secondary outcome measure was the ocular surface status based on fluorscein staining and schirmer’s wetting.

Results:

55eyes of 42 patients with SJS underwent cataract surgery. All eyes underwent surface stabilization procedures (punctal cautery, mucous membrane graft) preoperatively improving surface staining (0-3 group) from 27% to 78%. Phacoemulsification was the preferred technique(29/55). 49/55 eyes had varying grades of corneal scarring requiring topography Sim K (27/55) for IOL calculation, chandelier illumination(28/55) and 38/55 trypan blue intraoperatively to improve visibility , optical iridectomy (10/55) and postoperatively PROSE (15/55) to improve vision. Complications included intraop capsular rent (0.1%),aphakia( 0.09%).The median preoperative BCVA (1.8 logmar ) improved to 0.4postoperatively(p<0.0001) at mean follow up of 24.8months.Postoperatively surface was stable with no complication.

Conclusions:

Cataract surgery is challenging in SJS because of associated dryness, ocular surface inflammation, forniceal shortening and corneal scar.Stabilization of ocular surface preoperatively not only improved the ocular surface but also prevented postoperative surface breakdown and further deterioration of vision due to corneal complications.Based on the density of the scar and cataract intraoperative adjuvants like illuminator and trypan blue improve visibility and postoperative use of PROSE lens further aid in improving the visual outcome. Our study thus highlights the need for a comprehensive approach to manage cataract in patients with SJS.

Financial Disclosure:

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