Abstract
Purpose :
Ocular Mucous Membrane Pemphigoid (OcMMP) is a chronic autoimmune condition that causes progressive cicatrizing conjunctivitis and shortening of the fornices. Our goal was to investigate the long-term outcomes of fornix reconstruction and cicatricial entropion repair in patients with OcMMP.
Methods :
Patients with a diagnosis of OcMMP that underwent fornix reconstruction (with amniotic membrane/buccal mucosal graft) or cicatricial entropion repair by the same surgeon (PJD) between January 1, 2000, to September 1, 2020, were analysed. Patients included in the study had a positive biopsy suggesting OcMMP and/or clinical features of OcMMP or pseudo-pemphigoid. Patients were graded from stages 1 to 4 according to the Foster Classification. The primary outcome was the overall success of fornix reconstruction based on whether there was restoration of a deep fornix at the last follow up appointment. Secondary outcomes included areas of trichiasis, restriction in ocular motility and visual loss from corneal injury.
Results :
Ten patients with a diagnosis of OcMMP (80% Foster classification of 3-4) were enrolled (5 males and 5 females, median age: 78) as well as three patients with pseudo-OcMMP (2 females and 1 male, median age: 88). Mean follow up time was 24.9 ± 29.1 months from the initial surgery. Six of the OcMMP patients underwent fornix reconstruction and five underwent entropion repair. In eight OcMMP patients with consistent follow-up, loss of fornix depth or reformation of symblepharon was found on average at 7.1 ± 7.0 months post-operatively. Only one OcMMP patient maintained a deep fornix and half of the patients required an additional corrective surgery. Three patients had an average decrease in visual acuity of 1.75 ± 1.09 logMAR and went on to have evisceration or enucleation surgeries. Recurrence of trichiasis occurred in all but one patient. Eight patients were on systemic immunosuppressive therapy at the time of surgery, but there was no difference in success of outcome between medically treated and non-treated cases. Pseudo-OcMMP patients were noted to have short-term benefit from surgical intervention.
Conclusions :
This is the first study reviewing the long-term outcomes of fornix reconstruction and cicatricial entropion repairs in cases of OcMMP, and while initial results are beneficial, these largely reverse an average of 7 months following the interventions.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.