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Arturo E. Grau, Valerie P J Saw, Gurjeet Jutley, David Verity, John Kenneth George Dart, Richard Collin; MUCOUS MEMBRANE GRAFTS IN OCULAR CICATRICIAL PEMPHIGOID: SCHIRMER’S TEST AND LONG TERM FORNIX DEPTH OUTCOMES.. Invest. Ophthalmol. Vis. Sci. 2017;58(8):560. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
Conjunctival fornix reconstruction using a labial, buccal or hard palate mucous membrane graft to restore mucosal surface area, is sometimes necessary for correction of advanced fornix contracture in ocular cicatricial pemphigoid (OCP). The aim of this study was to evaluate long term outcomes of mucous membrane grafts in OCP including fornix depth measurements, and identify optimum criteria for successful fornix reconstruction.
Retrospective review of 25 OCP eyes receiving mucous membrane graft fornix reconstruction at Moorfields Eye Hospital between 1997 – 2010. Average follow up duration was 54 ± 30 months.
Indications included ankyloblepharon (32%), exposure with lagophthalmos (32%) and entropion with lid shortening (36%). For the 12 wet eyes with Schirmer’s test ≥5mm, mean fornix depth appeared to be maintained long term and measured 6 ± 1 mm in the lower fornix, and 10 ± 3 mm in the upper fornix. For the 13 dry eyes with Schirmer’s test <5mm, mean lower fornix depth was smaller 3 ± 2 mm (p=0.005), and upper fornix depth 9 ± 3 mm. Final visual acuity was 0.34 ± 0.3 in the wet eyes, and 0.18 ± 0.3 in dry eyes (p=0.24). All eyes were immunosuppressed for at least 4 months prior to the mucous membrane graft, and systemic immunosuppression was increased post-operatively in 4 eyes. Complications including bacterial keratitis (20%), persistent epithelial defect (16%), surface failure (8%) and recurrent entropion (28%) occurred most frequently in the dry eyes.
Eyes with Schirmer’s test 5mm or more do best with mucous membrane grafting in OCP, with long term maintenance of inferior conjunctival fornix and good visual acuity. Control of inflammation with systemic immunosuppression prior to mucous membrane graft surgery, and increased postoperative immunosuppression where necessary, is a requirement for success of the procedure.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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