LONG-TERM RESULTS OF MUCOUS-MEMBRANE GRAFTING IN OCULAR CICATRICIAL PEMPHIGOID - IMPLICATIONS FOR PATIENT SELECTION AND SURGICAL CONSIDERATIONS

Background: Buccal mucous membrane grafting was performed in 26 eyes o f 20 patients with advanced ocular cicatricial pemphigoid. The disease causes abnormalities of the eyelid margin and conjunctiva, which resu lts in mechanical damage to the cornea. The authors' short-term result s showed that mucous membrane grafting was effective in reversing thes e abnormalities if the disease was first medically controlled by chemo therapy or was in remission. Methods: At the end of 2 years of follow- up, the authors reviewed all records and photographs of these patients . Results: Serious postoperative corneal complications developed in 16 eyes (61.5%), causing worsened visual acuity in 8. The postoperative complications were associated with severe keratoconjunctivitis sicca i n 14 eyes (87.5%), progression of subepithelial conjunctival fibrosis and postoperative exacerbation of ocular cicatricial pemphigoid inflam matory activity in 8 eyes, and advanced ankyloblepharon in 7 eyes. The condition of one eye was unchanged. The beneficial effect of grafting was maintained in nine eyes. Conclusions: The authors' observations i ndicate that mucous membrane grafting should not be performed when pat ients have severe keratoconjunctivitis sicca, very advanced ocular cic atricial pemphigoid, or active conjunctival inflammation uncontrolled by immunosuppression. The authors suggest complete control of inflamma tion before surgery and perioperative treatment with systemic predniso ne while maintaining any ongoing immunosuppressive chemotherapy. The s election of alternative surgical approaches is discussed.