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Ocular cicatricial pemphigoid review
C Stephen Foster1, Maite Sainz De La Maza
1Department of Ophthalmology, Harvard Medical School, Immunology and Uveitis Service, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts 02114, USA. fosters@uveitis.org
Current Opinion in Allergy and Clinical Immunology
|September 7, 2004
Summary
Ocular mucous membrane pemphigoid causes scarring of the conjunctiva and cornea. Medical therapies like daclizumab and surgical options like keratolimbal allografts show promise for visual rehabilitation.
Area of Science:
- Ophthalmology
- Immunodermatology
Background:
- Ocular mucous membrane pemphigoid (OMMP) leads to progressive cicatrizing conjunctivitis, causing conjunctival and corneal scarring.
- Key molecular factors like macrophage-colony-stimulating factor and TGF-β1 may contribute to inflammation and scarring.
Purpose of the Study:
- To review recent advancements in the medical and surgical management of ocular mucous membrane pemphigoid.
- To identify factors influencing prognosis and visual rehabilitation in OMMP patients.
Main Methods:
- Review of current literature on medical therapies including daclizumab, IVIg, and methotrexate.
- Evaluation of surgical interventions such as amniotic membrane transplantation and keratolimbal allografts.
- Analysis of prognostic indicators and postoperative management strategies.
Main Results:
- Daclizumab, intravenous immunoglobulin (IVIg) therapy, and methotrexate demonstrate efficacy in medical management.
- Subconjunctival mitomycin is not effective for long-term control of inflammation and scarring.
- Boston scleral lenses improve vision and ocular comfort; amniotic membrane transplantation and keratolimbal allografts are used for ocular surface reconstruction.
- Prognosis is influenced by preoperative tear function and postoperative inflammation or graft rejection.
Conclusions:
- Daclizumab or IVIg therapy, improved surgical candidate selection, and optimized perioperative care for grafts can enhance visual outcomes.
- Careful patient selection and management are crucial for successful surgical interventions in OMMP.