Management and outcome of cataract surgery in ocular cicatricial pemphigoid

Background: Patients with ocular cicatricial pemphigoid (OCP) lose vision d ue to corneal disease or cataract, which may be senile, drug induced or com plex. The success of cataract surgery in these patients may be limited by a n increased risk of surgical complications due to difficult access and visu alisation, exacerbation of the cicatrising disease following surgery or lat er progression of the corneal disease. We report our experience on cataract surgery in OCP. Methods: Cataract surgery was performed on 15 eyes of 13 p atients. In the pre- and postoperative examinations the stage of the condit ion (according Foster's classification), the degree of conjunctival hyperae mia and the visual acuity (VA) were evaluated and topical and systemic medi cation recorded. All procedures used a corneal incision. The technique was intracapsular (ICCE) in 1, extracapsular (ECCE) in 4 and phacoemulsificatio n in 10 eyes. In 13 of 15 cases an intraocular lens was implanted. The unop erated fellow eyes constituted a control group. Duration of postoperative f ollow-up was 35.8+/-39.1 months. Results: 10 of 15 eyes had stage III disea se or worse before surgery, Two eyes following ECCE showed early postoperat ive progression of the disease. Postoperative visual acuity improved in 14 eyes by 2 or more lines. Preoperatively 5 eyes met the criteria for blind r egistration, whereas postoperatively all eyes achieved a VA of at least 0.1 . In 6 eyes the VA was sufficient to allow driving. However, by the 22nd po stoperative month progressive cicatricial and ocular surface disease result ed in a regression of the achieved visual rehabilitation in 8 eyes. Conclus ion: OCP does not prevent successful cataract surgery if appropriate techni ques are used and precautions taken. Systemic perioperative immunosuppressi on is necessary in patients with active conjunctival inflammation. The use of small clear corneal incision surgery is recommended to reduce the risk o f an acute exacerbation of conjunctival inflammation. Although visual rehab ilitation may be only temporary due to progression of the conjunctival or c orneal disease in OCP cataract surgery can provide some benefit, in severel y disabled patients, without precipitating an acute exacerbation of OCP.