Cataract surgery in chronic Stevens–Johnson syndrome: aspects and outcomes Purvasha Narang, 1 Ashik Mohamed, 2 Vikas Mittal, 3 Virender S Sangwan 1 ▸ Additional material is published online only. To view please visit the journal online (http://dx.doi.org/10.1136/ bjophthalmol-2015-308041). 1 Tej Kohli Cornea Institute, L V Prasad Eye Institute, Hyderabad, India 2 Prof. Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, India 3 Cornea and Anterior Segment Services, Sanjivni Eye Care, Ambala City, India Correspondence to Dr Virender S Sangwan, Tej Kohli Cornea Institute, L V Prasad Eye Institute, L V Prasad Marg, Banjara Hills, Hyderabad 500034, Telangana, India; vsangwan@lvpei.org Received 27 October 2015 Accepted 27 January 2016 Published Online First 22 February 2016 To cite: Narang P, Mohamed A, Mittal V, et al. Br J Ophthalmol 2016;100:1542–1546. ABSTRACT Aim To assess the outcome of cataract surgery in patients with chronic sequelae of Stevens–Johnson syndrome (SJS). Methods Setting: Tertiary eye care centre in South India. Design: Retrospective, non-comparative, consecutive, interventional case series. Study period: March 2003 to May 2014. Of the 1662 consecutive patients with SJS, 32 patients (40 eyes) with chronic sequelae of SJS who underwent cataract surgery were included. The main outcome measures were best- corrected visual acuity (BCVA) and ocular surface stabilisation. The visual acuity was expressed with reference to the logMAR. Results The study included 12 men (37.5%) and 20 women (62.5%). 8 patients (25%) had bilateral cataract surgeries. The median preoperative BCVA was 1.61 (IQR, 0.80 to 2.78) (only perception of light in three eyes). The median BCVA in the immediate postoperative period was 0.60 (IQR, 0.30 to 1.48) (perception of light in an eye) which was significantly different from the preoperative BCVA (p<0.0001). The median BCVA achieved was 0.30 (IQR, 0.00 to 0.80), suggesting further improvement. Median time taken to achieve this postoperatively was 1.5 months (IQR, 8 days to 3 months). The median BCVA during the last follow-up was 0.48 (IQR, 0.18 to 1.00). The preferred type of cataract surgery was phacoemulsification. Ocular surface condition remained stable in 35 eyes (87.5%). Ocular surface breakdown in four eyes (10%) was managed appropriately. Conclusion Cataract surgery outcome can be visually rewarding in chronic sequelae of SJS provided ocular surface integrity is adequately maintained preoperatively and postoperatively. INTRODUCTION Stevens–Johnson syndrome (SJS) is a complex immunological syndrome characterised by an acute blistering affecting the skin and at least two mucous membranes. 1 In the eye, it can present with acute and chronic manifestations. 2 Chronic ocular sequelae occur in up to 35% of patients. 3 Even if the cornea is not affected during the acute stage, severe loss of vision due to persistent and prolonged conjunctival inflammation and ulcer- ation, cicatricial complications of the lid margin and the tarsus, corneal scarring and neovascularisa- tion can result. 4 This can cause profound bilateral blindness if not managed in a timely and appropri- ate fashion. Visual rehabilitation in such cases is centred on improvement in ocular surface health, contact lenses and ocular surface prosthesis, cataract extrac- tion, corneal transplantation and keratoprosthesis. Cataract surgery is often delayed or not attempted in these patients due to the potential risks involved. 5 This study aims to highlight the appro- priate management of cataract and the outcomes of cataract surgery in patients with the chronic seque- lae of SJS. MATERIALS AND METHODS The approval of the Institutional Review Board was obtained and the study adhered to the tenets of the Declaration of Helsinki. This was a retrospective, non-comparative, consecutive, interventional case series carried out at the L V Prasad Eye Institute, Hyderabad, India. A total of 1662 patients were diagnosed to have SJS during the study period (March 2003 to May 2014). The systemic diagnosis was confirmed by a physician on presentation. Among these, the medical records of all the patients with chronic sequelae of SJS (n=32) who underwent cataract surgery (40 eyes) were reviewed and included in the study ( figure 1). A detailed history and complete ophthalmic examination, including the results of fluorescein staining and Schirmer type 1 test, were recorded for each patient. The age at presentation, duration of disease, duration of diminution of vision, best- corrected visual acuity (BCVA) at presentation, type of cataract surgery done and its outcomes were noted. The main outcome measures were BCVA and stability of the ocular surface. The logMAR to Snellen equivalent visual acuity conversion (and vice versa) was based on the published visual acuity conversion chart. 6 The statistical analysis was done using the soft- ware Origin (V.7.0; OriginLab Corporation, Northampton, Massachusetts, USA) and STATA (V.11.0; StataCorp, College Station, Texas, USA). The normality of the continuous data was assessed using the Shapiro–Wilk test. Mean and SD were used to describe the data with normal distribution, whereas median and IQR were used for description of data whose distributions were not normal. The Levene’s test for equal variance was applied to evaluate homoscedasticity in group-wise compari- sons. The paired t test was used to compare the continuous parametric data (equal variance), whereas Wilcoxon signed-rank test was used for non-parametric data and continuous parametric data (unequal variance). A p value of <0.05 was considered statistically significant. RESULTS The study included 12 men (37.5%) and 20 women (62.5%). Eight patients (25%) had bilateral cataract surgeries. The median age of the patients at presentation was 49 years (IQR, 35 to 56 years). The median duration of SJS at presentation was 1542 Narang P, et al. Br J Ophthalmol 2016;100:1542–1546. doi:10.1136/bjophthalmol-2015-308041 Clinical science