Corneal higher-order aberrations in Stevens-Johnson syndrome and toxic epidermal necrolysis

Purpose: To characterize the topography patterns and quantify corneal higher-order aberrations (HOAs) in the chronic phase of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). Methods: This retrospective, consecutive case series included 84 eyes of 49 patients in the chronic phase of SJS/TEN. HOAs of the total cornea, and of the anterior and posterior surfaces were measured using anterior segment optical coherence tomography (AS-OCT). Corneal topography patterns were classified into one of the 4 types: ectasia-, asymmetric-, flattening- and minimal change- patterns. Results: Mean logarithm of the minimal angle of resolution (logMAR) was 0.93 ± 0.95. AS-OCT showed ectasia pattern in 16 eyes (19.0%), asymmetric pattern in 28 eyes (33.3%), flattening pattern in 11 eyes (13.0%) and minimal change pattern in 29 eyes (34.5%). The HOAs of the total cornea were 1.23 ± 1.04 μm within a 4-mm diameter, which were significantly larger than those in normal controls (P < 0.0001). LogMAR visual acuity was significantly correlated with corneal HOAs (4-mm: r = 0.793, P < 0.0001, 6-mm: r = 0.798, P < 0.0001) and corneal astigmatism (r = 0.508, P < 0.0001), but not with average keratometric value (r = 0.198, P = 0.065). When the participants were stratified based on corneal opacity, logMAR was significantly correlated with corneal HOAs within a 4-mm diameter in opacity grades 0 (35 eyes, r = 0.649, P < 0.0001), 1 (23 eyes, r = 0.678, P = 0.0004), and 2–3 (26 eyes, r = 0.570, P = 0.0024). Ectasia pattern was derived from either corneal thinning (68.7%) or epithelial hyperplasia (31.3%). Conclusions: The most common topographic patterns for SJS/TEN were minimal change pattern and asymmetric pattern. Corneal HOAs were associated with decreased visual acuity in SJS/TEN.