1. WEILL.CORNELL.EDU Outcomes of Acute Interventions for SJS/TEN Using a Novel Grading Scale and Treatment Algorithm World Cornea Congress VII Jessica B. Ciralsky, Kelley J. Bohm, Cecilia Nicol, Ana G. Alzaga-Fernandez, Mark I. Rosenblatt, Kimberly C. Sippel. The authors have no relevant financial interests to disclose. April 15 – 17, 2015 1

2. INTRODUCTION Ophthalmic interventions during the acute phase of Stevens-Johnson Syndrome (SJS) and toxic epidermal necrolysis (TEN) have been shown to improve ophthalmic outcomes. In this study, we aim to assess our long-term outcomes of patients with acute SJS or TEN who were treated acutely according to a novel acute stage grading scale and associated treatment algorithm. 2

3. METHODS Retrospective case series: – 18 patients, 36 eyes Inclusion criteria: – Biopsy proven SJS or TEN – Ophthalmic involvement of any degree – Presented within 7 days of disease onset – At least 1 month of follow-up 3

4. ACUTE STAGE GRADING SCALE GRADING SCALECLINICAL DESCRIPTION MILDCONJUNCTIVITIS WITH CONJUNCTIVAL SLOUGHING MODERATELOCALIZED MODERATE CONJUNCTIVAL SLOUGHING SEVEREPROGRESSIVE, EXTENSIVE CONJUNCTIVAL SLOUGHING &/OR CORNEAL INVOLVEMENT EXTREMEEXTENSIVE SLOUGHING OF CONJUNCTIVA, LID MARGINS AND CORNEA 4 4

5. ACUTE STAGE GRADING SCALE & TREATMENT ALGORITHM 5 GRADING SCALECLINICAL DESCRIPTIONTREATMENT MILDCONJUNCTIVITIS WITH CONJUNCTIVAL SLOUGHING ARTIFICIAL TEARS AND LOCAL STEROIDS MODERATELOCALIZED MODERATE CONJUNCTIVAL SLOUGHING LOCAL STEROIDS AND LARGE DIAMETER BANDAGE CONTACT LENS SEVEREPROGRESSIVE, EXTENSIVE CONJUNCTIVAL SLOUGHING &/OR CORNEAL INVOLVEMENT AMNIOTIC MEMBRANE APPLICATION EXTREMEEXTENSIVE SLOUGHING OF CONJUNCTIVA, LID MARGINS AND CORNEA MULTIPLE AMNIOTIC MEMBRANE APPLICATIONS

6. RESULTS Outcomes measure: – Visual Acuity 14 patients, 28 eyes – 100% achieved 20/40 or better vision 4 patients, 8 eyes – Unable to measure visual acuity formally due to age or altered mental status 6

7. RESULTS Severe: Amniotic membrane application 7 FEW MONTHS LATERACUTE STAGE

8. RESULTS Outcome measure: – Corneal clarity 34 of 36 eyes (94%) – Completely clear corneas 2 of 36 eyes (6%) – Mild corneal opacification – Both eyes still had 20/40 or better vision 8

9. RESULTS Severe: Amniotic membrane application 9 FEW MONTHS LATERACUTE STAGE

10. RESULTS Extreme: Multiple amniotic membrane applications 10 FEW MONTHS LATER ACUTE STAGE

11. CONCLUSIONS Excellent outcomes were achieved in our patients with acute SJS or TEN by classifying the severity of ophthalmic involvement using a novel acute stage grading scale and then treating according to an associated treatment algorithm. 11

12. WEILL.CORNELL.EDU Sources Acknowledgements Weill Cornell Dept. of Ophthalmology 12 Gregory DG, Stevens-Johnson Syndrome: A New Grading System For The Acute Ocular Manifestations. 6 th World Cornea Congress. Boston. April 8, 2010.