A novel protocol for cataract surgery in patients with cicatrizing ocular surface disease

Session Details

Session Title: Moderated Poster Session: Focus on Multifocal IOLs and Cataract Surgery
Session Date/Time: Friday 21/02/2020 | 14:00-15:00
Paper Time: 14:00
Venue: Poster Area


First Author: A.Lazaridis GERMANY
Co Author(s): N. Alfahad  M. Ahmad  S. Rauz           

Abstract Details

Purpose:

To present the clinical outcomes, complications and visual rehabilitation after cataract surgery in patients with cicatrizing ocular surface disease (COSD) under perioperative administration of intravenous methylprednisolone and amniotic membrane transplantation

Setting:

Birmingham and Midland Eye Centre, Birmingham, UK

Methods:

Medical records of 129 consecutive cataract surgeries from 2005 through to 2019 on patients with COSD were reviewed. All patients underwent phacoemulsification with amniotic membrane transplantation and received intravenous methylprednisolone pre- and postoperatively. One hundred and two cases with ocular mucous membrane pemphigoid (oMMP;n=75), Stevens-Johnson syndrome (SJS;n=5) / toxic epidermal necrolysis (TEN;n=3) and atopic keratoconjunctivitis (AKC;n=19) with a minimum 6-month follow-up were included. The COSD was in all cases under control for at least 3 months before surgery. In fifty-four cases the patients were receiving long-term systemic immunosuppression therapy. The clinical outcomes, complications and best-corrected visual acuity (BCVA) were analysed.

Results:

In oMMP group, BCVA improved from 1.19±0.71 logMAR units to 0.33±0.38 (3-month;P=0.000) and 0.43±0.46 (6-month;P=0.000). Conjunctival inflammation was noted in 18 cases (minimal n=4; mild n=13, moderate n=1) and corneal complications in 14 cases (filaments n=3, punctate keratopathy n=5, persistent epithelial defects n=3, thinning n=3). Progression of cicatrisation was recorded in 1 case (1.3%). In SJS/TEN group, BCVA improved from 0.94±0.83 to 0.51±0.61 (3-month;P=0.043) and 0.54±0.97 (6-month;P=0.018). One case developed conjunctival inflammation. In AKC group, BCVA improved from 1.71±0.74 to 0.40±0.46 (3-month;P=0.000) and 0.54±0.40 (6-month;P=0.001). One case developed corneal erosion.

Conclusions:

Clear cornea cataract surgery on patients with COSD under perioperative administration of intravenous methylprednisolone and amniotic membrane transplantation may result in significant improvement of visual acuity with reduced incidence of progression of the cicatrization and corneal complications.

Financial Disclosure:

None