| Abstrakt: |
■ Early diagnosis and appropriate treatment of ocular mucous membrane pemphigoid (MMP) will prevent its severe sight-threatening complications. After excluding other causes of conjunctival scarring, a clinical diagnosis of ocular MMP, based on a history of progressive scarring and typical clinical signs, is sufficient. A negative immunofluorescence biopsy does not exclude the diagnosis of ocular MMP ■ Once the diagnosis has been made, it is important to first eliminate and treat local ocular surface disease causing inflammation such as blepharitis, dry eye or exposure, microbial infection, and toxicity ■ Persisting inflammation, following treatment of surface disease, is due to the underlying immune disorder and usually requires systemic immunosuppression ■ By using a stepladder strategy for immunosuppressive therapy, the risk of a poor initial response in mild to moderate disease is justified by less toxicity and the undiminished prospects of further therapeutic success with more toxic agents, whilst in aggressive disease initial treatment with toxic agents is justified ■ Providing the ocular surface inflammation is controlled, clear corneal incision cataract surgery is safe and does not require increased perioperative immunosuppression. Preoperative lid and conjunctival cultures and treatment of pathogenic colonization is recommended ■ Lid split and lamellar repositioning, or retractor plication surgery, for mild to moderate cicatricial entropion does not involve incising conjunctiva and increased immunosuppression is not necessary, but close follow-up to detect and treat any disease exacerbation is recommended ■ Fornix reconstruction surgery, and other surgery involving operating directly on the conjunctival fornices carries a high risk of a severe disease exacerbation and requires increased systemic immunosuppression for at least 2 months prior to embarking on surgery, along with a short perioperative course of oral corticosteroids ■ Keratoplasty and ocular surface reconstructive surgery to rehabilitate vision have a very guarded prognosis in ocular MMP, due to the problems of poor epithelialization, melt, infection, corneal vascularization, and disease reactivation in a hostile environment, and are contraindicated in dry eyes ■ Keratoprosthesis surgery is high risk and complications are frequent, but good visual outcomes can be achieved [ABSTRACT FROM AUTHOR] |
