The Second Affiliated Hospital of Xi'an Medical University, Eye Center, Ocular Immunology and Inflammation Institute, Shaanxi Provincial Clinical Research Center for Ophthalmology, Xi'an 710038, China.
Department of Ophthalmology, Peking University Third Hospital, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing 100191, China.
Oxid Med Cell Longev. 2022 Apr 30;2022:2496649. doi: 10.1155/2022/2496649. eCollection 2022.
To observe the outcomes of cataract surgery in ocular cicatricial pemphigoid (OCP) patients and explore routine perioperative medical treatments.
Retrospective case series.
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.
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.
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.
观察眼瘢痕性类天疱疮（OCP）患者白内障手术后的结果，并探讨常规围手术期的医学治疗方法。
回顾性病例系列。
本研究纳入了 8 名患者的 14 只眼。Foster 1-4 期 OCP 患者接受了人静脉免疫球蛋白治疗，而处于活动期炎症的患者则接受了泼尼松片和甲氨蝶呤治疗。对甲氨蝶呤不耐受且炎症症状严重的患者，给予环磷酰胺治疗。所有患者在全身治疗稳定三个月后，进行白内障手术。通过免疫荧光显微镜评估结膜活检。然后，根据是否存在睑球粘连将患者分为两组。记录 OCP 分期、手术类型、最佳矫正视力（BCVA）、泪液分泌试验（Schirmer I 试验）、角膜荧光素钠染色、睑板腺缺损范围和眼表疾病指数（OSDI）评分。随访时间为局部和全身用药时间。
9 只眼（64.29%）由女性和 4 只眼（35.71%）由男性被诊断为 OCP。平均随访时间为 60.64±35.62 个月。7 名患者中有 13 只眼（92.86%）接受了超声乳化白内障吸除术。1 只眼接受了超声乳化白内障吸除联合羊膜移植术。1 只眼接受了白内障囊内摘除术。所有患者的 BCVA 均显著提高，直至末次随访时仍保持稳定。Schirmer I 试验值高于术前。术后角膜荧光素钠染色评分较术前降低。术后 BCVA 显著提高。存在睑球粘连的患者 OSDI 评分显著高于不存在睑球粘连的患者。术后的睑球粘连与术前相比无显著差异。
在本系列中，OCP 合并白内障的患者能够接受超声乳化白内障吸除术，而常规使用免疫抑制药物和术后密切随访是必要的。
