Observation Of Cataract Surgery In Ocular Cicatricial Pemphigoid

Objective: To observe the clinical effect of cataract surgery in ocular cicatricial pemphigoid patients,and preliminary evaluate the safety and effectiveness of the surgery.Methods: 14 eyes of 8 patients ocular cicatricial pemphigoid patients with cataract of years between January 2010 and December 2018 were diagnosed at The Second Affiliated Hospital of Xi’an Medical University(Foster’s staging 1-4).Patients with mild symptoms were given human intravenous immunoglobulin,patients with mild or moderate active inflammation were treated with prednisone tablets combined with methotrexate,and those with intolerance to methotrexate and severe inflammatory symptoms were treated with cyclophosphamide.Cataract surgery for all patients was performed after 3 months in a stable condition,and the conjunctival biopsy was used to immunofluorescence microscopy.Patients were divided into two groups according to the presence or absence of ankyloblepharon.Then,the postoperative followed up time was 1 day,1 week,1 month,3 months,6 months,1 year,2 years and final time.The disease stage,type of surgery,best-corrected visual acuity(BCVA),Schirmer I test,corneal fluorescein sodium staining,the range of lack meibomian gland,Ocular surface disease index(OSDI)scoring scale,quantity and duration of topical,systemic medication were recorded preoperative and postoperative.At the same time,slit-lamp microscopic examination recorded conjunctiva,cornea,anterior segment and the status of symblepharon,and compare with the preoperative level.The complications were noticed after surgery and any progress of the disease.Results: 9 eyes of 5 patients were female(64.29%),and 5 eyes of 3 patients were male(35.71%).The youngest patient was 51 years old,and the oldest was 72 years old,then the average age was 66.11±6.33.The mean follow-up time was 60.64±35.62 months.13 eyes of 7 patients surgery performed were Phacoemulsification,and 1 eye of them combined with amniotic membrane transplantation.1 eye of 1 patient surgery performed was Intracapsular extraction of cataract.The BCVA improved significantly in all the patients by more than 4 lines of logarithmic visual acuity chart,which remained stable till the last follow-up,and the difference was statistically significant(P < 0.001).The Schirmer I test was higher than that before the operation,and the corneal fluorescein sodium staining showed a decrease in the score compared with the preoperative.The difference was statistically significant(P<0.01).The difference of BCVA between the group without ankyloblepharon and the group with ankyloblepharon was statistically significant on the first day after surgery(P<0.05),and the difference of Schirmer I test and corneal fluorescein sodium staining between groups was not statistically significant.The OSDI scores of patients with ankyloblepharon before and after surgery were higher than those without ankyloblepharon,and the difference was statistically significant(P<0.01),but the comparison within the group at each time point was not significant.No patients had exacerbation of symblepharon and the range of lack meibomian gland after cataract surgery,and there was no significant difference compared with the existing symblepharon and lack before surgery.Conclusion: In this series,ocular cicatricial pemphigoid patients with cataract may be performed in patients with phacoemulsification surgery,but these patients must be perioperative immunosuppression and postoperative close follow-up.