Shock Syndromes II

ii.

Cyclosporine—Information from individual case series suggests benefit at a dose of 3 mg/kg/d.

There are no formal recommendations for routine use.

iii.

Cyclophosphamide—Early case reports suggested benefit, but cyclophosphamide is not

recommended.

iv.

Colony-stimulating factor—May be used in conjunction with cyclosporine in patients with

neutropenia and TEN

IVIG

decrease keratinocyte apoptosis.

1 g/kg/d for 3 days) over SCORTEN-estimated mortality rates and similar control groups,

respectively.

study, available prospective studies have been small and single center. Results from these

studies, however, have shown no benefit to trends of worse outcomes.

identified prognostic factors for chronic ocular complications in patients with SJS and

TEN (Ophthalmology. 2015;122(2):254-264). Conducted as a retrospective, comparative,

multicenter study across 3 university hospitals in Korea, it included 43 patients diagnosed

with SJS or TEN. The treatments were categorized into 5 groups: systemic steroids, IVIG,

combined steroids and IVIG, systemic pulse steroids, and supportive care only. The study

measured outcomes according to BCVA and chronic ocular surface complications score

(COCS) at the final follow-up. Despite the varied treatments, there were no significant

differences in final BCVA and COCS between the groups after adjusting statistically.

High COCS was notably associated with female sex and the use of amniotic membrane

transplantation during the acute stage. In addition, severe acute ocular and systemic

involvement scores were linked to worse COCS, which correlated strongly with final BCVA.

The study concluded that systemic immunomodulatory treatments did not significantly

affect the final visual outcomes or COCS in patients, indicating that factors such as sex

and the severity of initial symptoms may be more critical in predicting long-term ocular

complications in SJS and TEN.

complications in patients with TEN (Eye (Lond). 2005;19(8):846-853). This retrospective,

historically controlled study compared 10 consecutive patients treated with high-dose

IVIG at Tan Tock Seng Hospital, Singapore, from July 2001 to June 2002, against 18

historical cohort patients diagnosed with TEN between July 1995 and June 2001 who did

not receive IVIG. The treated group received 2 g/kg of IVIG over 2 days. The analysis

showed that 90% of the patients treated with IVIG experienced ocular involvement, with

varying severity: mild complications like lid edema or mild conjunctival injection in 25%,

moderate complications such as pseudomembranes in 50%, and severe complications

including nonhealing epithelial defects with visual loss and symblepharon in 25%. In

contrast, 55.6% of the historical cohort experienced ocular issues, predominantly mild to

moderate, with no severe cases reported. The study concluded that IVIG treatment did not

significantly reduce the severity of visually significant ocular complications in patients

with TEN, suggesting a need for larger studies to confirm these findings.

standard of care.