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

Purpose To describe corneal ectasia in cases of chronic Stevens-Johnson syndrome (SJS). Design Prospective observational study. Methods Setting : Institutional. Patients : Fifteen consecutive cases of chronic SJS. Main Outcome Measures : Best-corrected distance visual acuity (BCDVA), maximum corneal curvature (Kmax), anterior elevation, posterior elevation, thinnest pachymetry, and Sotozono severity score. Results 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 42 μm (10-176 μm) and 267 μm (15-2392 μm), respectively. The mean pachymetry was 377.76 ± 165.05 μm (133-448 μm). The point of maximum ectasia was peripheral in 57.1%, both central and peripheral in 19.1%, and central in 23.8% of eyes. On Spearman correlation analysis, deterioration in BCDVA (R = 0.759, P P  = .005) was associated with higher disease severity (Sotozono grading). Conclusion 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.