Association of preoperative tear function with surgical outcome in severe Stevens-Johnson syndrome

Objective: To retrospectively study the surgical outcome in severe Stevens-Johnson syndrome (SJS). Design: Retrospective noncomparative case series. Participants: Twenty-nine eyes of patients with severe SJS associated with total conjunctivalization were examined. Intervention: Preserved human amniotic membrane grafting and keratolimbal allograft transplantation was performed. Intensive immunosuppression and epithelial management were continued postoperatively. Main Outcome Measures: Successful ocular surface reconstruction was determined by epithelialization with corneal epithelium. The association between surgical outcome and preoperative tear function was studied. Results: The ocular surface was successfully covered by corneal epithelium in 13 eyes (44.8%), The mean corrected visual acuity recovered from 0.0039 to 0.017. Persistent epithelial defect was the most common complication. Eyes with successful ocular surface reconstruction had significantly better preoperative Schirmer's test values (P = 0.025) and tear clearance rates (P = 0.043) than those that failed. Conclusions: In patients with severe SJS, preoperative tear function significantly influenced surgical outcome. Eyes with Schirmer's test value of >10 mm have a greater chance of successful ocular surface reconstruction. Ophthalmology 2000;107:1518-1523 (C) 2000 by the American Academy of Ophthalmology.