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.