Case Report: Management Of Corneal Thinning In A Patient With Ocular Cicatricial Pemphigoid (Ocp).

To present the clinical evolution, surgical and medical management of a patient with corneal thinning as a complication of ocular cicatricial pemphigoid and to show its clinical features and evolution revealed by anterior segment optical coherence tomography (AS-OCT) and anterior segment images.

Hospital Universitario Infanta Cristina. Department of opthalmology. Madrid, Spain.

A 84 year old female patient already followed in consultation for OCP in both eyes with blind left eye, presented with severe central corneal thinning (83 microns thick) in right eye over central subepiltelial fibrosis. The patient was under treatment with autologous serum and dapsone starting with doxycycline, ofloxacin, insulin eye drops, erythromycin and therapeutic contact lens. Penetrating keratoplasty was rejected due to the risk of corneal rejection and the patient's advanced age. Multilayer amniotic membrane transplantation with tissue adhesives was performed. A corneal perforation was eventually produced and sealed with conjunctival graft, cyanoacrylate and a new multilayer of amniotic membrane. Oral corticosteroids were started.

After the second surgical procedure, and replacing topical corticosteroids due to poor stromal tolerance with oral corticosteroids, a significant improvement was observed with an increase in corneal thickness up to 270 microns. Currently, under treatment with dapsone, doxicline, autologous serum, insulin and corticosteroids in a descending pattern, the thickness remains stable. Although he has suffered a conjunctivitis as a possible flare-up of OCP which is now in remission.

OCP is a rare, sight-threatening disease that affects older people, being a real challenge for the clinician. The main treatment is systemic immunosuppressives, and disease activity can be suppressed with early initiation of therapy. The disease must be treated by a multidisciplinary approach. Multilayer amniotic membrane transplantation and use of tissue adhesives may be considered part of the treatment in patients with inestable ocular cicatricial pemphigoid presenting with corneal thinning and risk of perforation.