When Surgery Does More Harm Than Good
Published 2025 - 43rd Congress of the ESCRS
Reference: PO016 | Type: Case Report | DOI: 10.82333/cdzg-jd64
Authors: Khaoula Boureguba* 1 , Ghita Halfi 1 , Youness Akannour 1 , Louai Serghini 1 , El hassan Abdallah 1
1Ophthalmology B,Specialities hospital,Rabat,Morocco
Purpose
Ocular cicatricial pemphigoid (OCP) is a chronic systemic autoimmune disease, characterized by progressive and fibrosing inflammation of the conjunctiva.
The success of cataract surgery in these patients may be limited by an increased risk of surgical complications due to exacerbation of the scarring disease or later progression of the corneal one.
The purpose of this work is to raise awareness among ophthalmologists in making sure that the patient is in a quiescent phase of the condition before doing any surgery due to a possible uncontrolled post-operative inflammation and scarring.
Setting
We report the case of a 57 years-old-female patient who underwent cataract surgery in her right eye. 2 weeks after, she came to the emergency room with a red, painful and tearing right eye, with a blurry vision and photophobia.
The patient underwent a thorough slit-lamp examination, additional supplementary tests were performed to assess severe dry eye syndrome, a conjunctival biopsy with direct immunofluorescence was also done to confirm the diagnosis of OCP.
Report of case
The corrected visual acuity was at hand motion in the right eye and at light perception in the left eye.
Slit lamp examination of the right eye revealed a blepharitis with meibomian gland dysfunction, subconjunctival fibrosis with shortening of the inferior fornix, diffuse superficial punctate keratitis, a large central corneal ulcer with neovascularization.
On the other hand, slit lamp examination of the left eye revealed a symblepharon with a total corneal opacification and neovascularization.
Conclusion/Take home message
Ocular cicatricial pemphigoid predominantly affects women over 60 years.
The skin and many other mucous membranes may be involved
It is important to stop disease progression before undergoing any surgery in order to prevent complications.
With long-term systemic therapy 90% of the cases can be efficiently controlled. While Dapsone is the first-line treatment in mild to moderate disease, more severe cases require immunosuppressant therapy.
Dry eye syndrome requires constant lubricating medication and topical steroids, cyclosporine-A before and after the surgery.
Surgery should be planned only in quiescent phase as minor conjunctival trauma can significantly worsen the disease leading to an uncontrolled post-operative inflammation and scarring