Anterior Segment Swept-Source Optical Coherence Tomography-based Assessment of Corneal Refractive Profiles in Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis Patients: A Controlled Comparative Study

Abstract

Purpose: To analyze anterior, posterior, and total corneal refractive profiles and thickness using anterior segment (AS) sweptsource optical coherence tomography (SS-OCT) in Stevens-Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN) patients.

Methods: This retrospective study compared 23 eyes from 14 patients with SJS/TEN with 23 eyes from 14 age- and sexmatched controls. AS SS-OCT measured corneal refractive profiles and pachymetry. Parameters included anterior, posterior, and total corneal power values, posterior to anterior curvature ratio, maximal corneal power, and thickness profiles. The SJS/TEN group was subdivided based on corneal opacity presence (subgroup A) or absence (subgroup B).

Results: The SJS/TEN group showed significantly higher corneal astigmatism and maximal corneal power values for both anterior and posterior curvatures. Steep total corneal power and total corneal astigmatism were higher in the SJS/TEN group. The thinnest corneal thickness was lower, and its distance from the corneal vertex was greater in the SJS/TEN group. Subgroup analysis revealed that these differences were primarily attributed to the presence of corneal opacity. Additionally, automated keratometry of the anterior corneal surface showed significantly higher values, including steep, flat, and average keratometry and corneal astigmatism, in the SJS/TEN group.

Conclusions: AS SS-OCT shows significant alterations in both anterior and posterior corneal curvatures in patients with SJS/TEN. These findings emphasize the importance of considering posterior corneal curvature changes in pre-cataract surgery assessments and contact lens prescriptions for patients with SJS/TEN.

Keywords: Anterior segment swept-source optical coherence tomography; Posterior corneal curvature; Stevens-Johnson syndrome; Toxic epidermal necrolysis.

Fig. 1

Representative slit-lamp biomicroscopic photographs and anterior segment swept-source optical coherence tomography corneal findings, including anterior axial maps, anterior tangential maps, posterior axial maps, and corneal pachymetry maps, from the control group and the Stevens-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN) group. (A–D) Two representative normal case. Regular, mild corneal astigmatism on both the anterior and posterior corneal surfaces is observed in the two normal cases from the control group. (E–H) Two representative SJS/TEN cases without corneal opacity. Regular anterior and posterior corneal astigmatism similar to that in normal cases is noted. (I–L) Two representative SJS/TEN cases with corneal opacity. Irregular and severe corneal astigmatism on both the anterior and posterior corneal surfaces is observed, along with inferior-dominant corneal thinning in both cases.