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目的分析Stevens-Johnson综合征(Stevens-Johnson syndrome,SJS)患者眼部并发症的临床特征。设计回顾性病例系列。研究对象2010年8月至2014年6月北京同仁医院眼科门诊因SJS综合征出现眼部并发症的45例患者。方法回顾分析患者病历资料,并对数据进行统计学分析。主要指标患者一般情况、病史及病程,症状、体征及相关性疾病以及临床处理。结果 45例患者(90眼),男性21例(46.7%),平均年龄(28.0±20.2)岁,均双眼发病。自SJS发病到眼科就诊的平均时间为(43.2±75.9)个月。眼表损害程度轻度者15眼(16.6%),平均视力Log MAR 0.55±0.91;中度者25眼(27.8%),平均视力Log MAR 0.52±0.82;重度者50眼(55.6%),平均视力Log MAR 1.33±1.05。眼部重度受累患者视力与轻、中度患者差异显著(P=0.038)。SJS发病年龄及病程时长与眼表严重程度分级相关性无统计学意义(P=0.47,0.143)。68眼(75.6%)并发干眼,63眼(66.7%)并发角膜病变,70眼(77.8%)并发眼睑结构改变及睑板腺功能障碍。结论 SJS可引起严重眼部并发症,发病后眼部浸润严重程度与发病年龄、性别、发病时长均无相关,及时合理地针对角结膜干燥、眼睑结构异常以及角膜病变的对症治疗可提高患者生存质量。
Objective To analyze the clinical characteristics of ocular complications in patients with Stevens-Johnson syndrome (SJS). Design retrospective case series. Subjects From August 2010 to June 2014, 45 patients with ocular complications due to SJS syndrome in Beijing Tongren Hospital ophthalmology clinic. Methods Retrospective analysis of patient medical records, and data for statistical analysis. The main indicators of patients in general, history and course of disease, symptoms, signs and related diseases and clinical management. Results 45 patients (90 eyes), 21 males (46.7%), the average age (28.0 ± 20.2) years old, both eyes disease. The average time from onset of SJS to ophthalmology was (43.2 ± 75.9) months. The mean visual acuity was Log MAR 0.55 ± 0.91; moderate degree was 25 eyes (27.8%), mean visual acuity Log MAR 0.52 ± 0.82; severe degree was 50 eyes (55.6%), average Visual Log MAR 1.33 ± 1.05. Visual acuity and mild to moderate ocular disease were significantly different in patients with ocular major involvement (P = 0.038). SJS age and course of disease duration and ocular surface severity grade correlation was not statistically significant (P = 0.47,0.143). 68 eyes (75.6%) with dry eye, 63 eyes (66.7%) with corneal lesions, 70 eyes (77.8%) with eyelid structural changes and meibomian gland dysfunction. Conclusions SJS can cause severe ocular complications. The severity of ocular infiltration after onset is not related to age of onset, sex, duration of onset, and timely and reasonable symptomatic treatment of keratoconjunctival dryness, eyelid structure abnormalities and corneal diseases can improve patient survival quality.