Chronic ocular complications in lamotrigine vs. trimethoprim-sulfamethoxazole induced Stevens-Johnson syndrome/toxic epidermal necrolysis

Purpose: The purpose of this study is to compare the severity of chronic ocular complications of Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) induced by lamotrigine (LT) vs. trimethoprim-sulfamethoxazole (TS). Methods: This retrospective cross-sectional study evaluated all SJS/TEN patients treated within our hospital network from 2008 to 2018. Inclusion criteria included patients with reactions identified as caused by either LT or TS, and patients with at least one ophthalmology follow up in the chronic phase (>= 3 months from disease onset). Primary outcome measures included LogMAR best-corrected VA at most recent visit and the presence or absence of severe ocular complications (SOC). Secondary outcome measures included chronic ocular complication severity scores using a modified Sotozono scoring system. Results: Forty-eight eyes of 24 patients were included in the study. The mean duration of follow-up was 39.50 +/- 35.62 vs. 48.17 +/- 33.09 months, respectively (p = 0.482). The LT group had worse average VA at the most recent visit (LogMAR VA; 0.508 vs. 0.041, p < 0.0001) and had a higher prevalence of SOCs (66.7% vs. 8.3%, p = 0.0038). The LT group scored worse on Sotozono chronic complications scores for the cornea (1.875 vs. 0.5, p = 0.0018), eyelid margin (5.583 vs.3.083, p = 0.0010), and overall condition (8.500 vs. 4.833, p = 0.0015). Subanalyses showed that a moderate or severe acute ocular severity score was a significant predictor of chronic outcomes. Conclusions: Compared to patients with TS-induced SJS/TEN, patients with LT-induced SJS/TEN developed worse chronic ocular complications on several parameters. Future prospective studies are warranted to provide additional insight into the drug type as a predictor of chronic ocular complications.

Automated summary

This study compared the severity of chronic ocular complications in patients with Stevens-Johnson syndrome/toxic epidermal necrolysis induced by lamotrigine vs. trimethoprim-sulfamethoxazole. It found that patients with lamotrigine-induced SJS/TEN had worse visual acuity at the most recent visit and a higher prevalence of severe ocular complications compared to those with trimethoprim-sulfamethoxazole-induced SJS/TEN.