Mucous membrane grafts in ocular cicatricial pemphigoid: Schirmer’s test and long-term fornix depth outcomes

Session Details

Session Title: Cornea Medical I

Session Date/Time: Monday 12/09/2016 | 17:00-18:30

Paper Time: 18:24

Venue: Hall C2

First Author: : V.Saw UK

Co Author(s): :    A. Grau   G. Jutley   J. McAlister   J. Dart   R. Collin   D. Verity     

Abstract Details

Purpose:

Conjunctival fornix reconstruction using a labial, buccal or hard palate mucous membrane graft to restore mucosal surface area, is sometimes necessary for correction of advanced fornix contracture causing exposure in Ocular Cicatricial Pemphigoid (OCP). The aim of this study was to evaluate long term outcomes of mucous membrane grafts in OCP including fornix depth measurements, and identify optimum criteria for fornix reconstruction.

Setting:

Moorfields Eye Hospital London UK

Methods:

Retrospective review of 21 eyelids of 19 OCP eyes receiving mucous membrane graft fornix reconstruction at Moorfields Eye Hospital between 2001 – 2010. Average follow up duration 47 ± 32 months (Range 8 – 153 months).

Results:

For the 11 wet eyes with Schirmer’s test 5mm or more, fornix depth was maintained long term and measured 6 ± 1 mm in the lower fornix, and 10 ± 4 mm in the upper fornix. For the 9 dry eyes with Schirmer’s test less than 5mm, lower fornix depth was 3 ± 2 mm indicating more contracture post-operatively, and upper fornix depth 10 ± 5 mm. Visual acuity was 0.42 ± 0.42 in the wet eyes, and 0.1 ± 0.3 in dry eyes. All eyes were immunosuppressed for at least 4 months prior to the mucous membrane graft.

Conclusions:

Eyes with Schirmer test 5mm or more do best with mucous membrane grafting in OCP, with long term maintenance of inferior conjunctival fornix and better visual acuity. Control of inflammation with systemic immunosuppression for at least 4 months prior to mucous membrane graft surgery is recommended.

Financial Disclosure:

NONE