OCULAR CICATRICIAL PEMPHIGOID EXACERBATED BY CATARACT SURGERY: A CASE REPORT

To describe a case of ocular cicatricial pemphigoid (OCP) that was triggered and worsened by cataract surgery, highlighting the clinical progression of the disease, management challenges, and the significance of imaging in monitoring the disease.

This case was managed in the ophthalmology emergency department of a secondary care hospital, with follow-ups for many months after.

An 88-year-old Caucasian male with a 10-year history of OCP was referred to our department due to corneal perforation in the left eye. He underwent cataract surgery in both eyes, his right eye in 2013 and his left eye in 2018. Both surgeries resulted in exacerbation of OCP symptoms. Treatment involved dapsone, cyclosporine eye drops, homologous serum, and artificial tears. The progression of the disease could not be controlled leading to severe corneal scarring in both eyes. Anterior segment optical coherence tomography (OCT) was used to evaluate the extent of damage.

The patient's best corrected visual acuity was hand movement perception in the right eye and light perception without projection in the left eye. Slit lamp biomicroscopy revealed total coverage of the cornea with conjunctival tissue and paracentral thinning of the corneal epithelium in the right eye, while in the left eye disclosed total coverage of the cornea with scar tissue and extensive surface keratinization and symblepharon. There was also a fibrous adhesion between the iris and the cornea in the central portion of the left eye, because of the corneal perforation. After prescription for 1 month of artificial tears with trehalose 3% and hyaluronic acid 0.15% and levofloxacin eye drops, the best corrected visual acuity improved in the right eye in counting fingers at 1 meter. The visual acuity remained stable during the next follow ups. Anterior segment OCT demonstrated keratinization of the surface of the cornea and fibrous adhesion between posterior corneal surface and iris.

This case report highlights that OCP can be exacerbated or even triggered by cataract surgery. In order to mitigate the risk of disease take off, it is crucial to employ appropriate surgical techniques and take precautions. Early diagnosis and multidisciplinary management are essential to prevent  severe vision loss. The use of anterior segment OCT can be a valuable tool in the evaluation and management of OCP.