Corneal Involvement Research Articles

Suspected corneal metastasis in a case of nasopharyngeal carcinoma

A 13-year-old girl child undergoing chemotherapy for the terminal stage of undifferentiated metastatic nasopharyngeal carcinoma presented to us with a complaint of poor vision in the left eye (LE). There were no complaints of pain, photophobia, or watering. On examination, there was asymmetric optic disc pallor in both eyes with a patch of corneal infiltration in the LE that was difficult to attribute to any obvious common pathology. The richly vascular posterior segment is a well-known target of ocular metastasis for several malignancies. Corneal involvement, if it occurs, is through local spread. However in this case, in the absence of any other factors to account for this corneal infiltration along with presence of adjacent corneal neovascularization, corneal metastasis is highly suspected. Unfortunately, histopathological evidence could not be collected due to the poor general health of the patient, who did not turn up for a follow-up.

Chemoimmunotherapy-Resistant Ocular Surface Squamous Neoplasia Managed With I-125 Brachytherapy

Purpose: The purpose of this study was to report the management of chemoimmunotherapy-resistant ocular surface squamous neoplasia (OSSN) with iodine-125 (I-125) brachytherapy. Methods: A 36-year-old man presented to the clinic with biopsy-proven OSSN that covered ∼70% of the corneal surface and extended to the 6 o'clock position of the inferior limbus of the OS. The visual acuity was 20/20 in the OD and 20/40 in the affected OS. He was treated with topical interferon alpha-2b 1 MIU/mL (4 times daily [QID] for 6 weeks) and then 4 cycles of topical 5-fluorouracil 1% (QID, 1 week on, 3 weeks off) with an incomplete response. He switched to topical mitomycin C 0.04% (QID, 1 week on, 2 weeks off) for 2 cycles and received a subconjunctival injection 25 mg (0.5 mL of a 50-mg/mL solution) of 5-fluorouracil. The tumor persisted. The patient was ultimately cured with placement of an 18-mm I-125 brachytherapy plaque for 97 hours (50 Gy). Results: Because of extensive corneal involvement and risks associated with surgery, an 18-mm I-125 brachytherapy plaque was placed over the cornea and limbus. The treatment led to full resolution of the tumor within 1 month of treatment and recovery of 20/20 vision in the affected eye. Thirty-two months after treatment, the patient developed a visually significant posterior subcapsular cataract OS and underwent successful phacoemulsification surgery, returning to 20/20 vision. He has remained tumor-free for over 55 months. Conclusions: This case highlights the efficacy and safety of I-125 brachytherapy as an alternative for intraepithelial OSSN unresponsive to conventional chemoimmunotherapy, particularly when extensive surgical excision poses significant risks.

Rapport de cas d’un ulcère de Mooren sévère

Mooren's ulcer is a painless and idiopathic ulcer of the peripheral cornea related to autoimmunity provided by a corneal stromal antigen that is calgranulin C. Corneal involvement is isolated. There are no specific histological features to differentiate Mooren's ulcer from pseudo-Mooren's, the latter being part of a systemic disease. Mooren ulcer is a diagnosis of elimination based on a complete etiological check-up. However, histological examination, when performed, could provide additional data to support the diagnosis.We report the case of a 78-year-old female patient who presented with Mooren's ulcer. The patient had complained of red eye and photophobia for two weeks. Initial visual acuity was "counting fingers". Clinical examination revealed a perforated perilimbic ulcer with an iris prolapse. Due to the peripheral ulcerative keratitis, with a negative etiological work-up and anatomopathological analysis of the pathological cornea, the diagnosis of Mooren's ulcer was proposed.This rare case illustrates the need for a multidisciplinary approach involving ophthalmologists, pathologists, and internists, to obtain an etiological diagnosis and optimize the functional prognosis.

Mpox Keratitis: A Case Report and Review.

Mpox is a rare infectious disease. Lack of knowledge among eye care professionals regarding mpox keratitis greatly reduces the likelihood of diagnosis and effective management. This report and review seek to increase the knowledge of mpox keratitis among eye care professionals. We report a patient with mpox keratitis who underwent successful penetrating keratoplasty, with 20 years of follow-up. A systematic literature search and review of cases of mpox keratitis from 1970 to 2024 was performed. A total of 24 articles and 2 abstracts reporting 35 cases of mpox keratitis were identified. A frequency of 0.5% to 1.0% may be the lower range of mpox keratitis among symptomatic patients with a confirmed mpox diagnosis. Mpox keratitis occurred with and without systemic mpox. Initial misdiagnoses were common (40%). Polymerase chain reaction results aided clinical diagnosis. Corneal disease ranged from mild epitheliopathy to fulminant ulcerative keratitis. Outcomes ranged from 20/20 acuity to no light perception. In the absence of fulminant systemic disease, tecovirimat was associated with clinical improvement of mpox keratitis in almost all cases. Our case is the only known report of successful penetrating keratoplasty for mpox keratitis and the only case whereby monkeypox virus was cultured from the corneal surface. Mpox keratitis is rare but can result in severe vision loss and blindness. Systemic tecovirimat seems to be effective in treating mpox keratitis, although the low frequency of keratitis precludes clinical trials. Topical steroids may extend virus survival in the cornea. Polymerase chain reaction may help confirm mpox corneal involvement.

Limbal Stem Cell Deficiency After Treatment of Ocular Surface Squamous Neoplasia.

To investigate limbal stem cell deficiency (LSCD) in patients surgically treated for ocular surface squamous neoplasia (OSSN). This retrospective case-control study investigated clinical and histological data from patients with OSSN surgically treated in a referral center. The study included 98 patients (58 male, 40 female) with a mean age of 61.1 (23-86) years. Less than 3 clock hours were involved by OSSN in 48 eyes (49.0%), 3-6 clock hours in 32 eyes (32.7%), 6-9 clock hours in 12 eyes (12.2%), and more than 9 clock hours in 6 eyes (6.1%). Limbal stem cell deficiency was identified in 36 patients (36.7%) after surgery. The severity of LSCD was mild in 17 eyes, moderate in 11, and severe in 8. The prevalence of LSCD increased significantly in groups with 6 clock hours or more of OSSN involvement (p < 0.001). The affected limbal side (superior, inferior, nasal, or temporal) had no significant association with the prevalence of LSCD (p = 0.869). Patients with recurrent OSSN had a higher LSCD prevalence (p = 0.003). The higher the tumor stage, the more likely it was to develop LSCD (p < 0.001). Patients with corneal involvement were also more likely to develop LSCD (p = 0.021). The prevalence of LSCD was raised with increasing histopathological grade (p = 0.019). Furthermore, solely the number of clock hours affected by OSSN was an independent risk factor in multivariate analyses (p < 0.001). The size and severity of OSSN and the presence of recurrent OSSN are associated with an increased likelihood of developing LSCD. Furthermore, the extent of the limbal area involved by the OSSN is identified as an independent risk factor of the development of LSCD.

Suture-Less and Glue-Less Amniotic Membrane Graft for Keratopathy and Early Keratinization in Drug Reaction With Eosinophilia and Systemic Symptoms Syndrome

Purpose: Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome can cause significant keratopathy and lead to lasting visual effects. The main objective of this study was to describe an ocular presentation of DRESS treated with a modified suture-less and glue-less amniotic membrane graft technique. This study also provides a literature review of ocular DRESS manifestations and ocular management of the other severe cutaneous adverse reactions. Methods: This is a case review about an 82-year-old man with sepsis due to recent Mycobacterium tuberculosis, who presented with DRESS based on clinical findings. Results: The patient was treated with a modified suture-less and glue-less amniotic membrane graft technique along with a Prokera corneal bandage placement. The patient had significant improvement of visual acuity and symptoms with this technique. Conclusions: Patients with significant corneal and conjunctival involvement associated with DRESS, similar to Stevens–Johnson syndrome/toxic epidermal necrolysis (SJS/TEN), may benefit from more aggressive treatment with amniotic membrane transplantation and Prokera corneal bandage placement to prevent scarring and subsequent vision loss. The modified technique described in this article can be used for patients who may be poor candidates for the operating room.

Peripheral ulcerative keratitis secondary to tuberculosis: A case report and literature review.

Compared with intraocular tuberculosis, ocular tuberculosis with ocular surface involvement is rare. Corneal involvement in ocular tuberculosis may include interstitial keratitis or peripheral ulcerative keratitis. We report a case of peripheral ulcerative keratitis directly caused by tuberculosis. A 20-year-old man complained of vision loss and pain in the left eye that had lasted for 1 week. A slit lamp examination of the left eye showed a corneal epithelial defect, interstitial corneal edema, and a white irregular infiltrative lesion and ulcer (with the dimension of 2 × 2.5 mm) in the inferior temporal region. The corneal ulcer was scraped, and the Mycobacterium tuberculosis deoxyribonucleic acid polymerase chain reaction was positive. After a month of oral antituberculosis treatment, the corneal ulcer resolved, and the intraocular inflammation improved. Peripheral ulcerative keratitis secondary to tuberculosis can be directly caused by M tuberculosis.

Acute and chronic ocular outcomes in SJS/TEN patients treated with oral ciclosporin vs intravenous immunoglobulin.

To evaluate differences in ocular complications of Stevens Johnson Syndrome (SJS)/Toxic Epidermal Necrolysis (TEN) patients receiving either systemic IVIG or Ciclosporin (CsA) as initial treatments. Retrospective review of consecutive patients admitted for SJS/TEN at the Singapore General Hospital (SGH) from 2011 to 2017 who received either IVIG or Ciclosporin at the onset of the disease and had ophthalmological follow-up of at least 6 months were included. Acute ocular severity of SJS/TEN was graded using the Gregory grading score; chronic ocular complications were graded using the Sotozono system. A total of 18 subjects were included for analysis, with eight in the IVIG group and 10 in the CsA group. There were no significant differences in acute Gregory severity grading between the two groups. The CsA group had a trend towards worse overall chronic Sotozono grading scores compared to the IVIG group (median [IQR]: 2 [0-3] vs. 1 [0-6.5], p = 0.27), with a higher incidence of acute severe cornea involvement (60% vs. 25%, p = 0.93) and chronic corneal and eyelid involvement in the former than the latter. SJS/TEN patients with worse acute ocular involvement were more likely to have TEN and perianal mucosal involvement (50% vs. 0, p = 0.01). Compared to those who received IVIG, SJS/TEN patients who received CsA at the acute disease stage, seemed to have worse acute corneal and chronic corneal and eyelid complications. Larger studies are needed to confirm this finding.

Biomarker Detection and Validation for Corneal Involvement in Patients With Acute Infectious Conjunctivitis

Infectious conjunctivitis can lead to corneal involvement and result in ocular morbidity. The identification of biomarkers associated with corneal involvement has the potential to improve patient care. To identify biomarkers in patients with acute infectious conjunctivitis. This cross-sectional study took place from December 2016 to March 2024. Analyses were performed in 3 phases. First, logistic regression and machine learning algorithms were used to predict the probability of demonstrating corneal involvement in patients with presumed infectious conjunctivitis. Second, quantitative reverse transcription polymerase chain reaction (RT-qPCR) was used to confirm the most important biomarker gene identified by the algorithm. Third, the biomarker gene was validated in prospectively collected conjunctival samples of adult patients from 3 outpatient centers in Thailand and 1 in India. Patients with signs and symptoms of infectious conjunctivitis and onset within less than 14 days were eligible. Exclusion criteria were the inability to consent, presumed toxicity, or allergic conjunctivitis. Acute infectious conjunctivitis. The identification and validation of ocular surface gene expression associated with corneal findings on slitlamp examination. Thirteen genes exhibited a 1.5-log2 fold change in expression in patients with corneal involvement compared to patients without corneal involvement. Using the 13 genes to train and cross validate, logistic regression produced the highest mean area under the receiver operating characteristic curve (AUROC; 0.85; 95% CI, 0.84-0.86) for corneal involvement. The removal of apolipoprotein E (APOE) from the gene ensemble led to a decline in predictive performance of the logistic regression classifier (from mean AUROC 0.85 [95% CI, 0.84-0.86] to 0.74 [95% CI, 0.73-0.75]; adjusted P = .001 [Tukey test]). Orthogonal testing of APOE expression level with RT-qPCR showed that APOE expression was higher in patients with corneal involvement compared to patients without (median [IQR], 0.23 [0.04-0.47] vs 0.04 [0.02-0.06]; P = .004 [Mann-Whitney U test]). Using a Youden index of 0.23 Δ threshold cycle, APOE had a sensitivity of 56% (95% CI, 33-77) and a specificity of 88% (95% CI, 79-93) in 106 samples with conjunctivitis at Aravind, India (P < .001 [Fisher exact test]). When applied to a different patient population in Thailand, the same criteria could discriminate between disease states (58 samples; sensitivity, 47%; 95% CI, 30-64 and specificity, 93%; 95% CI, 77-99; P = .001 [Fisher exact test]). The results from this study suggest that the host conjunctival immune response can be meaningfully interrogated to identify biomarkers for ocular surface diseases.

Adverse effects of anti-cancer biologics on the ocular surface.

Cancer immunotherapy is one of the most emerging and rapidly growing fields.Ocular side effects associated with these therapies are common and can be present in up to 70% of patients.The cornea may be involved in different pathogenic mechanisms triggered by different immunotherapeutic agents, and corneal disease varies from mild symptoms to severe corneal ulceration and melting with visual loss.We aimed to review the incidence, mechanism, and management of ocular surface side effects in cancer patients receiving immunotherapy. With the recent use of immunotherapeutic agents in cancer patients, in particular immune checkpoint inhibitors (ICIs) and epidermal growth factor receptor (EGFR) inhibitors, ocular surface and corneal involvement are common side effects.These patients can be at risk of sight threatening complications that warrant prompt diagnosis and careful monitoring and management. Immunotherapy- related corneal complications in cancer patients are associated with a decreased quality of life. Prompt recognition and an interdisciplinary approach between ophthalmologists and oncologists are crucial to handle immune related ocular adverse events in these patients, in order to maintain ocular surface integrity and avoid a vision threatening complication.

Refractive and topographic corneal changes associated with increased inflammatory mediators in tears after COVID-19

This is a rare case report of a sudden shift to myopic astigmatism and topography alterations in a patient who experienced mild coronavirus disease 2019 (COVID-19) symptoms. A complete ophthalmologic evaluation, slit-lamp examination, corneal topography, and tear sampling for biochemical analysis were performed. Elevated corneal K-values were found, indicating abnormal anterior corneal curvature, based on the asymmetric corneal steepening index (cone location and magnitude index) in a Galilei G6 study. Tear analysis demonstrated elevated levels of interleukin (IL)-1β, IL-6, IP-10, IL-8, interferon-β, and prometalloproteinase-9. Ophthalmologists should maintain a high level of suspicion when symptoms suggestive of corneal involvement arise in patients recently infected with severe acute respiratory syndrome coronavirus 2.

Factors associated with the quality of corneas retrieved for transplantation by Eye Banks: a scoping review protocol

IntroductionThe cornea is an avascular and transparent layer of connective tissue crucial to retinal image quality. Diseases can impair its quality, affecting vision. Keratoplasty is the only therapy capable of...

Herpes Zoster Ophthalmicus Recurrence: Risk Factors and Long-Term Clinical Outcomes

To examine the frequency of recurrences, risk factors, and long-term clinical outcomes in subjects with herpes zoster ophthalmicus (HZO). Retrospective cohort study. All subjects with acute HZO seen at a single center from 2006 to 2016 were included in the study. The primary outcome measure was eye disease recurrence. The secondary outcome measure was moderate vision loss (≤20/50). A total of 869 patients with acute HZO were identified, with a median follow-up time of 6.3 years (interquartile range 3.7-8.9 years). In all, 551 recurrences were observed, and at least 1 recurrence was seen in 200 subjects (23.0%), with uveitis (34.8%) being the most common. The median time to first recurrence was 3.5 months. Predictors of disease recurrence included immunosuppression (P = .026), higher presenting intraocular pressure (P = .001), corneal involvement (P = .001), and uveitis (P < .001) on multivariate analysis. Topical steroids were initiated in the first month of presentation in 437 subjects, and recurrence was observed in 184 (42.1%) of these subjects. Following cessation of topical steroid treatment, recurrence occurred after a median of 1.4 months (90% within 7 months). Moderate vision loss (≤20/50) occurred in 15.5%, 28.6%, 31.4%, 50.0%, and 57.4% of eyes with 0, 1, 2, 3, and 4 or more recurrences. Recurrence of HZO eye disease is common, with an increased risk of vision loss with more recurrences. These findings indicate the need for close monitoring for potential recurrences, especially after cessation of topical steroid treatment, and in individuals with identified risk factors for recurrence.

Long-Term Corneal Endothelial Parameters of COVID-19 Patients With Ocular Surface Symptoms.

This study aimed to investigate the long-term effects of COVID-19 on corneal endothelial cell morphology in patients with ocular symptoms to assess possible corneal involvement in patients who recovered. The COVID-19 group included patients diagnosed and treated at Istanbul University Cerrahpasa Medical Faculty with confirmed SARS-CoV-2 infection and ocular irritation symptoms. The control group was comprised of age- and sex-matched individuals. The controls had no ocular pathologies. Noncontact specular microscopy (Konan Cell Check SL, Hyogo, Japan) was performed using the center method after 156 ± 16 days of COVID-19 diagnosis. Parameters such as endothelial cell density (ECD), hexagonality (HEX), coefficient of variation, and central corneal thickness were analyzed. Specular microscopy results of 54 COVID-19 patients with ocular irritation symptoms and 72 controls were evaluated. Ocular symptoms in COVID-19 patients included conjunctival hyperemia, foreign body sensation, tearing, ocular secretion, and chemosis. Mean (±SD) ECD was 2770 ± 31 (cells/mm 2 ) in the COVID-19 group and 2897 ± 26 in the control group, and mean (±SD) HEX was 46.52 ± 6.38 in the COVID-19 group and 58.22 ± 13.94 in the control group. COVID-19 patients exhibited significantly lower endothelial ECD and HEX levels than controls ( P = 0.003 and P < 0.001, respectively). Coefficient of variation and central corneal thickness analyses did not reach statistical significance. COVID-19 can cause long-term alterations in the corneal endothelial cells, leading to decreased ECD and HEX. Future research should focus on the long-term implications of COVID-19 on the corneal health and visual outcomes.

A rare case of crystalline deposits over Descemet’s membrane in a suspected case of monoclonal gammopathy of undetermined significance

Monoclonal gammopathy of undetermined significance (MGUS) is a premalignant disorder that can give way to multiple myeloma and related plasma cell disorders. In patients with MGUS, ocular involvement is rare, although several cases of crystalline deposits in the corneal stroma have been reported which may be unilateral or bilateral.[1-4] Along with stromal deposits, corneal involvement may happen with varied presentations making imperative to be differentiated from corneal degenerations and dystrophies. We report a suspected case of MGUS presenting with uniocular involvement in the form of crystalline deposits over Descemet’s membrane, which is an infrequent manifestation of the occult systemic disorder.

Pattern of Adenoviral Conjunctivitis Reported to Tertiary Care Hospitals During Epidemic in Pakistan

Purpose: To determine clinical pattern of “adenoviral conjunctivitis” during its epidemic in Pakistan.&#x0D; Patients and Methods: 370 patients (550eyes) diagnosed with “adenoviral conjunctivitis” were included in this descriptive study. Diagnosis was made by the combination of characteristic clinical features and a positive conjunctival swab PCR for “adenovirus”. Clinical pattern of “adenoviral conjunctivitis” was determined by documenting various patient characteristics. Data were analyzed using SPSS 22.&#x0D; Results: Median age of the study participants was 28.50 (1.00 – 67.00) years. 195 (52.70%) were males and 175 (47.30%) were females. 190 (51.35%) patients had unilateral ocular involvement, while 180 (48.65%) patients had bilateral ocular involvement. Median number of family members of patients that were infected simultaneously was 1 (0-5). Frequency of patients with “adenoviral conjunctivitis” who had concomitant corneal involvement was 30 (8.1%)&#x0D; Conclusion: Epidemic of “adenoviral conjunctivitis” in Pakistan, fortunately, exhibits a milder and benign clinical pattern with higher prevalence in males and mostly involving single eye. In addition, only 8.1% patients have concomitant corneal involvement.

Acute conjunctivitis – antibiotic susceptibility and resistance to different antibiotics in main Eye Hospital, Tripoli, Libya

Acute conjunctivitis is characterized by inflammation of the conjunctiva of less than 3 to 4 weeks duration, cellular infiltration, and exudation. It may also result in corneal, lid, or orbital involvement which may lead to various complications. Bacterial conjunctivitis is a self-limiting process, but topical antibiotic treatment is recommended to eradicate the pathogen and reduce symptom duration. A hospital-based prospective study was conducted in the emergency and casualty department in Zawyat Aldahmani Eye Hospital, Tripoli /Libya comprising out-patients (OPD) visiting the department from June to December 2019 (186 cases). The primary objective was to evaluate the bacteriological pattern and the secondary objectives were to evaluate seasonal variation and antibiotic sensitivity pattern of the isolates. Conjunctival swabs included patients from both sexes (males n_106 and females n_80) and different ages; 80.1% of adults of the whole studied cases and the rest were children under 12 years old. Staph. hominis (26.17%) was the predominant organism isolated throughout the study. The commonest single organism isolates were Staph. haemolyticus (11.21%) Staph. aureus (9.35%). All isolates were identified and susceptibility patterns towards about 34 different antibiotics were studied. There were 186 patients enrolled. Of all cultures, 57.5% (107) yielded one of the study pathogens. Gram-positive organisms were isolated from 83 (77.57%) of cultures, gram-negative organisms were isolated from 15 (14.02%), and 9 (8.4%) were fungal growth. From 107 gram-positive isolates, 19 samples (22.9%) gave coagulase-positive results and 64 samples (77.1%) gave negative results. All the major organisms (S. aureus, S. hominis, S. hemolytic, S. epidermidis, E. coli, Mycobacterium, and Moraxilla catarrhalis) susceptible to cephalosporins, macrolides, aminoglycosides and fluoroquinolones (levofloxacin). Tetracycline has the lowest effect on both gram-positive and gram-negative isolates. In conclusion, our findings should alert physicians on the choice of appropriate antibiotic treatment after applying AST to the identified strains and on the potential role of conjunctivitis in the spread of antibiotic-resistant pathogens. In addition, external bacterial infections of the eye were most frequently caused by the common skin bacteria. Staphylococci spp. was by far the most common bacterial pathogen.

Clinical spectrum in microbiologically proven Demodex blepharokeratoconjunctivitis: An observational study.

To study the demographic, clinical, and microbiological profile of Demodex-related blepharokeratoconjunctivitis (BKC) at a tertiary eye care hospital. This retrospective observational study was conducted from January 2016 to September 2022. It included 83 patients with microbiologically proven Demodex BKC who presented to the cornea department of our tertiary care eye center. The clinical, microbiological, and demographic data of the 83 cases were analyzed. Of the 83 cases, 57 (68.67%) were younger than 40 years, and 25 (30.12%) were below 20. Most patients presented with a good visual acuity of 20/40 or better (93 eyes; 84.55%). The disease was unilateral in 55 patients and bilateral in 28. Cylindrical dandruff was the predominant presentation noted in 61 eyes (54.95%), followed by corneal scarring in 47 eyes (42.34%) and corneal vascularization in 40 eyes (36.04%). On light microscopy, 87.95% of the positive samples were identified as Demodex folliculorum , 7.23% as Demodex brevis , and 6.02% remained unidentified. Tea tree oil and lid scrubs eradicated the disease in most patients clinically (75/83, 90.36%). The spectrum of BKC includes both lid signs and corneal involvement. It can be a cause of recurrent BKC and detection of the mite by microscopic evaluation of the lashes can confirm the diagnosis. In most cases, the tea tree oil can effectively manage this condition. However, low doses of topical steroids are needed to control the inflammation in patients with corneal involvement.

EFFECTIVENESS AND SAFETY OF AMNIOTIC MEMBRANE GRAFTING FOR CORNEAL SURFACE DISORDER: A RANDOMIZED CLINICAL STUDY

Objective: The aim of the study was to evaluate the effectiveness and safety of freeze-dried amniotic membrane grafting (AMG) and compare it against traditional medical therapy for the management of corneal surface disorders. Methods: A randomized clinical trial was conducted on 60 patients with corneal surface disorders who were randomized equally either into the AMG group (n=30) or medical management group (n=30). Patients in both groups were followed up for 8 weeks after receiving group-specified intervention or till complete resolution (whichever was earlier). Treatment outcome, healing time, improved vision, decreased pain, recurrence rate, and corneal clarity were the main outcome metrics. Results: The most common corneal disorder was persistent epithelial defect (38.33%), closely followed by impending perforated corneal ulcer (31.66%). Majority of the patients (36.66%) had corneal involvement of &gt;75%, while 31.66% had involvement ranging from 50 to 75%. The success rate of AMG (96.7%) was significantly higher than that of medical management (76.7%) in the treatment of corneal surface disorders (p=0.022). During the follow-up period, the incidence of allergic reactions was slightly lower in the AMG group (6.7%) compared to the medical management group (10.0%). Overall, the incidence of side effects and other complications was low in both the AMG group and the medical management group. The severity of side effects was comparable in both the study groups (p=0.886). The recurrence rate of corneal surface disorders in the in the AMG group (6.7%) was statistically lower than that in the medical management group (26.7%) (p=0.037). Conclusion: The findings of the present study supported the use of AMG as an effective and safe alternative to medical management for the treatment of conditions affecting the corneal surface.

Ocular Mucous Membrane Pemphigoid: The Effect of Risk Factors at Presentation on Treatment Outcomes

PurposeAnalyze the influence of risk factors at presentation in the long-term immunosuppressive therapy (IMT) outcomes of ocular mucous membrane pemphigoid (OMMP). DesignRetrospective multicenter study. ParticipantsOMMP patients seen at Duke Eye Center, Tecnologico de Monterrey, and Hospital Clinic of Barcelona from 1990–2022. MethodsData at presentation on demographics, direct immunofluorescence and ocular findings, extraocular sites of involvement (EOM) and prior treatments, in patients with a clinical and/or laboratory diagnosis of OMMP, were analyzed with multivariable analysis and Kaplan-Meier plots to identify factors associated with adverse outcomes. Main outcome measures(1) inflammatory control (no conjunctival inflammation in both eyes at three months on IMT); (2) relapse (new-onset inflammation after absolute control in either eye); (3) progression (≥1 cicatrizing stage progression in either eye); and (4) vision loss (>2 Snellen lines). Results117 patients (234 eyes), 61% (71/117) women, with a mean age of 66.6 (standard deviation (SD) 12.4, range: 37–97) years and a median follow-up of 34 (interquartile range Q1 16, Q3 66; range: 3–265) months. Inflammatory control was achieved in 57% (67/117) patients, with high-risk EOM (HR-EOM), including esophageal, nasopharyngeal, and/or genital [adjusted odds ratio (aOR) 12.51; 95% confidence interval (CI), 2.61–59.99; P=0.002] and corneal scarring (aOR 3.06; 95% CI, 1.15–8.14; P=0.025) as significant risk factors for persistent inflammation. Disease relapse, progression, and vision loss occurred in 20% (23/117), 12% (14/117), and 27% (32/117) of patients, respectively. Baseline corneal scarring was a risk factor for relapse [adjusted hazard ratio 4.14; 95% CI, 1.61–10.62; P=0.003], progression (aOR 11.46; 95% CI, 1.78–73.75; P=0.010), and vision loss (aOR 3.51; 95% CI, 1.35–9.10, P=0.010). HR-EOM was associated with stage progression (aOR 34.57; 95% CI, 6.57–181.89; P<0.001) and vision loss (aOR 8.42; 95% CI, 2.50–28.42, P=0.001). There were no significant differences between IMT regimes and relapse (P=0.169). ConclusionsOMMP presenting with HR-EOMs and corneal scarring has an increased risk of stage progression and vision loss. Corneal scarring and severe inflammation at baseline were associated with an increased risk of relapse. A disease progression staging system incorporating both the HR-EOMs and corneal involvement is required to predict the visual outcome of OMMP better.