Clinical Factors Associated with Late Ocular Complication in Toxic Epidermal Necrolysis

毒性表皮溶解症病人之晚期眼部併發症與其相關因子

李修安(Hsiu-An Lee) ； 胡瀞暄(Ching-Hsuan Hu) ； 鍾文宏(Wen-Hung Chung) ； 莊秀樹(Shiow-Shuh Chuang) ； 楊瑞永(Jui-Yung Yang)

《臺灣整形外科醫學會雜誌》 24卷3期 (2015/09) Pp. 229-238

摘要

背景：毒性表皮溶解症是罕見但會危及生命的嚴重皮膚反應。病人會伴隨有眼部的侵犯並帶來晚期眼部併發症影響其生活品質。目的及目標：了解毒性表皮溶解症存活者的晚期眼部併發症，相關危險因子及預防方式。材料及方法：回溯性調查於1992年至2009年期間因毒性表皮溶解症住至林口長庚醫院燙傷照護中心或皮膚科病房之患者。結果：50.5%（51／101）的病人有眼部侵犯，其中24位有存活出院並在本院追蹤至少五年。在這些病人中，13位有晚期眼部併發症，而其中三人因瘢痕性眼瞼內翻或未癒合的角膜表皮缺損接受手術。我們發現與病人眼部預後相關的因素有急性期的角膜表皮缺損以及病人發病後到就診的間隔時間。SCORTEN的分數與眼部侵犯沒有關聯。結論：一經診斷毒性表皮溶解症，建議儘早照會眼科醫師介入評估及治療，以減少病人的晚期眼部併發症。

並列摘要

Background: Toxic epidermal necrolysis (TEN) is a rare and life threatening skin reaction. Patients develop ophthalmic involvement and debilitating late ocular complications. Aim and Objectives: To investigate late ocular complications in patients survived from TEN, and clinical factors associated with ocular complications. Materials and Methods: Retrospective chart review of patients hospitalized in Chang-Gung Memorial Hospital (CGMH) burn center and dermatology ward between the year 1992 and 2009 with diagnosis of TEN Results: 50.5% (51/101) of patients had ocular involvement, 24 of them survived and had been followed at our hospital for at least for 5 years. Among these patients, 13 had late complication and 3 patients received surgical intervention for cicatricial entropion and/or persistent corneal erosions. Factors found to be associated with late ocular complications are corneal epithelial defect at the acute stage and delay of treatment. The SCORTEN value did not correlate with the severity of eye involvement in the acute setting. Conclusion: Early evaluation and intervention by ophthalmologist of all TEN patients is suggested, in order to minimize late ocular complication.

並列關鍵字

toxic epidermal necrolysis ； ophthalmic manifestations ； late ocular complication ； topical steroids