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LETTER TO EDITOR
Year : 2007  |  Volume : 55  |  Issue : 6  |  Page : 483

Cataract surgery in Steven Johnson syndrome


Department of Ophthalmology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry - 605 006, India

Correspondence Address:
Smitha T Suchi
Department of Ophthalmology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry - 605 006
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0301-4738.36496

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How to cite this article:
Srinivasan R, Suchi ST. Cataract surgery in Steven Johnson syndrome. Indian J Ophthalmol 2007;55:483

How to cite this URL:
Srinivasan R, Suchi ST. Cataract surgery in Steven Johnson syndrome. Indian J Ophthalmol [serial online] 2007 [cited 2020 Feb 28];55:483. Available from: http://www.ijo.in/text.asp?2007/55/6/483/36496

Dear Editor,

We read with interest the article Phacoemulsification in total white cataract with Steven Johnson syndrome (SJS) by Vasavada et al . [1] The authors did not use topical steroids due to fear of infection after cataract surgery in an SJS patient. We feel postoperative topical steroid therapy is very important as ocular surface inflammation is an important factor causing corneal complications like melting. [2],[3] We have also had some experience in operating on patients with SJS. In all our cases we have used topical steroids postoperatively under antibiotic cover and adequate lubrication and have not encountered infection. We believe that with adequate antibiotic cover the risk of infection may be reduced.

Secondly, the authors have preferred a scleral incision for cataract surgery in a case of SJS due to the diseased cornea. Corneal melts have been reported in cases of cataract surgery done on patients with secondary Sjogrens syndrome with collagen vascular diseases. Surgery in SJS should be attempted on a quiet eye. We would like to emphasize that with adequate postoperative care and careful monitoring, the risk of corneal complications like melt is rare considering the fact that phacoemulsification incision is small. We feel that it is better to leave the conjunctiva virgin in view of the postoperative inflammation and difficulty in exposure during surgery due to severe fore shortening of fornices. Thus a corneal incision may be better in these cases as one can avoid peritomy and cautery causing least amount of disruption to the ocular surface. [4]

 
  References Top

1.
Vasavada AR, Dholakia SA. Phacoemulsification in total white cataract with Stevens-Johnson syndrome . Indian J Ophthalmol 2007;55:146-8.  Back to cited text no. 1
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2.
Katzung BG. Prostaglandins and other eicosonoids. In : Katzung BG, editor. Clinical pharmacology. Lange: California; 1984. p. 217-8.  Back to cited text no. 2
    
3.
Lu Y, Fukuda K, Liu Y, Kumagai N, Nishida T. Dexamethasone inhibition of IL-1-induced collagen degradation by corneal fibroblasts in three-dimensional culture. Invest Ophthalmol Vis Sci 2004;45:2998-3004.  Back to cited text no. 3
    
4.
Bissen-Miyajima H, Monden Y, Shimazaki J, Tsubota K. Cataract surgery combined with ocular surface reconstruction in patients with severe cicatricial keratoconjunctivitis. J Cataract Refract Surg 2002;28:1379-85.  Back to cited text no. 4
[PUBMED]  [FULLTEXT]  



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