Outcomes of Cataract Surgery in Ocular Cicatricial Pemphigoid

Puranik, Charuta; Murthy, Somasheila I; Taneja, Mukesh; Sangwan, Veena

doi:10.3109/09273948.2013.819106

Cited by 12 publications

(11 citation statements)

References 15 publications

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“…Similar to their findings, case 6 with OCP had a temporary visual improvement in early postoperative period, but visual acuity deteriorated 2 years later because of missed follow-up and uncontrolled disease. In contrast, Puranik et al argued that surgeries were not associated with exacerbations of inflammation, and that stable visual outcomes could be anticipated in spite of ongoing disease [ 29 ]. However, we strongly recommend adequate preoperative immunosuppression therapy and the use of small corneal incisions in cases with OCP scheduled for cataract surgery in order to ensure better outcomes.…”

Section: Discussionmentioning

confidence: 99%

Cataract surgery in patients with corneal opacities

Sun

Chen

2018

BMC Ophthalmol

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BackgroundInvestigating the efficacy and safety of phacoemulsification with intraocular lens (IOL) implantation in corneal opacities.MethodsThis retrospective study was conducted in a tertiary medical center. Twenty-three eyes of 19 patients with cataracts and corneal opacities obscuring the pupillary center having received phacoemulsification with IOL insertion without any ancillary techniques were enrolled. The primary study outcome measures were uncorrected and best corrected visual acuity (BCVA), and complications. Backscatters of corneal scar lesions were evaluated by slit lamp-based haze grading, Scheimpflug Pentacam and anterior segment optical coherence tomography (ASOCT). Visual outcomes after cataract surgeries and improvement range were used to determine the safety and efficacy of cataract surgery for our patients.ResultsAll patients underwent uneventful capsulorhexis and phacoemulsification. The mean age was 72.22 ± 10.1 years, and the mean follow-up period was 18.57 ± 15.42 months. The mean BCVA significantly improved from 1.45 ± 0.65 preoperatively to 0.94 ± 0.55 logMAR postoperatively (p < 0.001), and the number of eyes with a BCVA of 20/100 or better increased from 4 to 14. Complications included corneal edema in two eyes and reactivation of the previous corneal pathology in five eyes. Four eyes did not achieve an improvement in visual acuity after surgery, which may have been due to co-existing ocular co-morbidities. Both Pentacam corneal densitometry and ASOCT demonstrated no significant correlations with final visual outcome. However, a statistically significant relationship between the severity of corneal opacity and improvement range in BCVA (r = − 0.782, P = 0.001) was found by our OCT grading method.ConclusionsPhacoemulsification and IOL implantation in selected cases of coexisting cataracts and corneal opacities is safe that can provide suboptimal but long-term vision when penetrating keratoplasty is not possible or at high-risk of graft failure. ASOCT is a simple tool to predict visual outcomes after cataract surgery in opacified corneas.

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Section: Discussionmentioning

confidence: 99%

Cataract surgery in patients with corneal opacities

Sun

Chen

2018

BMC Ophthalmol

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“…Such patients should be treated with preservative-free artificial tear eye drops, topical steroids, or immunosuppressants. In the stable period of inflammation, OCP and Stevens-Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN) are safe for cataract extraction [ 11 , 12 ]. Cataracts are visual impairments caused by decreased transparency and refractive power of the lens.…”

Section: Introductionmentioning

confidence: 99%

“…When cataracts are associated with other ocular surface diseases, such as Steven-Johnson syndrome (SJS), OCP, silkworm corneal ulcer, spring keratoconjunctivitis, and limbal stem cell deficiency, the prognosis of visual quality is rarely reported [ 15 ]. Puranik et al's study reported the outcomes of cataract surgery in ocular cicatricial pemphigoid and found that cataract surgery could be safely performed with no major intra- or postoperative complications [ 11 ]. However, OCP patients often present common causes of cataracts, which may result in visual loss through aging, medication-induced or complex cataracts.…”

Section: Introductionmentioning

confidence: 99%

Perioperative Management and Long-Term Outcomes in Ocular Cicatricial Pemphigoid Patients Undergoing Cataract Surgery

Quan

Zhang

et al. 2022

Oxidative Medicine and Cellular Longevity

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Objective. To observe the outcomes of cataract surgery in ocular cicatricial pemphigoid (OCP) patients and explore routine perioperative medical treatments. Design. Retrospective case series. Methods. Fourteen eyes of 8 patients were included in the study. Foster’s stage 1-4 OCP patients were given human intravenous immunoglobulin, whereas patients with active inflammation were treated with prednisone tablets and methotrexate. Those who were intolerant to methotrexate and had severe inflammatory symptoms were treated with cyclophosphamide. Cataract surgery was performed for all patients after three months of systemic treatment under stable conditions. The conjunctival biopsy was evaluated by immunofluorescence microscopy. Then, patients were divided into individuals with or without ankyloblepharon. Records were reviewed for OCP stage, type of surgery, best-corrected visual acuity (BCVA), Schirmer I test, corneal fluorescein sodium staining, meibomian gland coloboma range, and ocular surface disease index (OSDI) scores. Follow-up was for the duration of taking topical and systemic medication. Results. Nine female (64.29%) and 4 male (35.71%) eyes were diagnosed with OCP by biopsy. The mean follow-up time was 60.64 ± 35.62 months. Thirteen eyes (92.86%) of 7 patients underwent phacoemulsification. One eye underwent phacoemulsification combined with amniotic membrane transplantation. The intracapsular extraction of cataract was applied to one eye. The BCVA improved significantly in all the patients, which remained stable until the last follow-up. The Schirmer I test was higher than that before the surgery. Corneal fluorescein sodium staining after surgery showed a decrease in score compared to the preoperative score. The BCVA of the patients after surgery increased significantly. The OSDI scores of patients with ankyloblepharon were significantly higher than for those without it. Postoperative symblepharon showed no significant difference compared to the preoperative symblepharon. Conclusions. In this series, OCP patients with cataracts were able to undergo phacoemulsification surgery, whereas routine use of immunosuppression and closed postoperative follow-up were necessary.

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“…In such eyes, any conjunctival surgery should be performed after adequate immunosuppression to control the postoperative exacerbation of surface inflammation and scarring, which are often severe and difficult to manage. 12 Our third patient, an elderly lady where the diagnosis was established later in the disease course, already had developed bilateral involvement when the diagnosis was established. Corneal involvement include punctate epitheliopathy, filamentary keratitis, exposure keratitis, which if not promptly addressed may progress to epithelial defects, corneal ulcer, and perforation.…”

Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 89%

Vortex Keratopathy as a Presenting Feature of Ocular Mucous Membrane Pemphigoid

Singh

Jain

Basu

et al. 2023

Cornea

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The aim of this study was to describe the presenting feature of vortex keratopathy in 3 patients with biopsy-proven ocular mucous membrane pemphigoid (OMMP). Methods:The first patient was a 52-year-old woman with chronic redness and foreign body sensation for 3 years who presented with unilateral vortex keratopathy. Seven months later, in the same eye, she developed conjunctival signs suggestive of OMMP. The second patient was a 33-year-old woman with similar chronic symptoms that were exacerbated by pterygium surgery. Clinical examination revealed vortex keratopathy in the right eye with subtle conjunctival signs suggestive of OMMP. The third patient was a 70-year-old woman with complaints of repeated episodes of redness and foreign body sensation for 18 months who presented with vortex keratopathy in the right eye and conjunctival signs suggestive of OMMP in the same eye. To confirm the clinical diagnosis, bilateral conjunctival biopsy was performed in all patients.Results: OMMP was diagnosed based on conjunctival signs and confirmed on direct immunofluorescence positivity, demonstrating antibodies characteristic and diagnostic of OMMP in the basement membrane zone. A unique feature that preceded or coexisted with the conjunctival signs was unilateral vortex keratopathy seen in all 3 patients, independent of the stage of the disease at which they presented.Conclusions: Vortex keratopathy can be a presenting feature in patients with OMMP. A complete ocular surface examination, especially checking the medial canthus for keratin and the inferior fornix for foreshortening, is necessary. Conjunctival biopsy should be performed in all cases to confirm the clinical diagnosis wherever required.

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Outcomes of Cataract Surgery in Ocular Cicatricial Pemphigoid

Cited by 12 publications

References 15 publications

Cataract surgery in patients with corneal opacities

Cataract surgery in patients with corneal opacities

Perioperative Management and Long-Term Outcomes in Ocular Cicatricial Pemphigoid Patients Undergoing Cataract Surgery

Vortex Keratopathy as a Presenting Feature of Ocular Mucous Membrane Pemphigoid

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