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      Role of mini-scleral lens in mucous membrane pemphigoid

      case-report

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          Abstract

          This study aims to report the use of mini-scleral contact lens in the management of mucous membrane pemphigoid (MMP) with persistent epithelial defects. A 68-year-old male with a history of ocular pain and declining visual acuity was referred to our clinic with a diagnosis of MMP. His corrected distance visual acuity (CDVA) was 20/200 in the right eye and 20/100 in the left eye. Despite being on lubricants, topical steroids and intravenous cyclophosphamide, the patient developed persistent corneal epithelial defects in both eyes. He was then given a trial of mini-scleral lenses. Within 4 weeks, corneal epithelial defects healed, and at 6 months, the CDVA had improved to 20/50 in the right eye and 20/40 in the left eye. By improving the corneal surface integrity and visual function, mini-scleral lenses can play a role in the visual rehabilitation of patients with MMP.

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          The first international consensus on mucous membrane pemphigoid: definition, diagnostic criteria, pathogenic factors, medical treatment, and prognostic indicators.

          Fenella Wojnarowska, Aabid Ahmed, Timothy K. Cooper … (2002)
          We aimed to develop consensus-based recommendations for streamlining medical communication among various health care professionals, to improve accuracy of diagnosis and treatment, and to facilitate future investigations for mucous membrane pemphigoid. Because of the highly specific nature of this group of diseases, the 26 invited participants included either international scholars in the field of mucous membrane pemphigoid or experts in cutaneous pharmacology representing the 3 medical disciplines ophthalmology, oral medicine, and dermatology. The first author (L.S.C.) conducted a literature search. Based on the information obtained, international experts who had contributed to the literature in the clinical care, diagnosis, and laboratory investigation for mucous membrane pemphigoid were invited to participate in a consensus meeting aimed at developing a consensus statement. A consensus meeting was convened and conducted on May 10, 1999, in Chicago, Ill, to discuss the relevant issues. The first author drafted the statement based on the consensus developed at the meeting and the participants' written comments. The draft was submitted to all participants for 3 separate rounds of review, and disagreements were reconciled based on literature evidence. The third and final statement incorporated all relevant evidence obtained in the literature search and the consensus developed by the participants. The final statement was approved and endorsed by all 26 participants. Specific consensus-based recommendations were made regarding the definition, diagnostic criteria, pathogenic factors, medical treatment, and prognostic indicators for mucous membrane pemphigoid. A system of standard reporting for these patients was proposed to facilitate a uniform data collection.
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            Advances in understanding and managing dry eye disease.

            Michael Lemp (2008)
            To present evidence from the literature and scientific meetings to support fundamental changes in concepts regarding the prevalence, pathogenesis, definition, diagnosis, management of dry eye disease (DED) and the prospects for the development of new therapies. Analysis and clinical perspective of the literature and recent presentations. Review and interpretation of literature. The tear film and ocular surface form an integrated physiologic unit linking the surface epithelia and secretory glands via a neural network. This sensory-driven network regulates secretory activity in quantity and composition, supporting the homeostasis of the system. The tear film forms a metastable covering between blinks, subserving clear vision, and maintains the health and turnover of the ocular surface cells. Disturbance of intrinsic factors such as increasing age; hormonal balance; systemic or local autoimmune disease, or both; systemic drugs or extrinsic factors including topical medications; environmental stress; contact lens wear; or refractive surgery result in a final common pathway of events at the tear film and ocular surface, resulting in DED. Diagnosis of DED and the design of clinical trials for new drugs have been hampered by a lack of correlation between signs and symptoms and flawed endpoints; successful new drug applications likely will require new approaches, such as the use of objective biomarkers for disease severity. Recent advances in our knowledge of the causation of DED open opportunities for improving diagnosis and disease management and for developing new, more effective therapies to manage this widely prevalent and debilitating disease state.
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              Gas-permeable scleral contact lens therapy in ocular surface disease.

              Tatiana Romero-Rangel, Panagiota Stavrou, Janis Cotter … (2000)
              To describe the therapeutic benefits of nonfenestrated gas-permeable scleral contact lenses in the management of patients with ocular surface disease. The charts of 49 consecutive patients (76 eyes) with ocular surface disease whose management included the use of gas-permeable scleral contact lenses were reviewed. We also developed a questionnaire to assess the impact of lens wear on subjective aspects of activities of daily living. The mean age of the 49 patients was 44.6 years (range, 3 to 87 years); 31 patients were female and 18 were male. The most common indication for fitting of the lenses was Stevens-Johnson syndrome (54 [71%] of the 76 eyes). Other indications included ocular cicatricial pemphigoid, exposure keratitis, toxic epidermal necrolysis, postherpetic keratitis, congenital deficiency of meibomian glands, superior limbal keratoconjunctivitis, Sjögren syndrome, and inflammatory corneal degeneration. The mean follow-up was 33.6 months (range, 2 to 144 months). Improvement in best-corrected visual acuity (defined as a gain of 2 or more Snellen lines) was observed in 40 (53%) of the eyes. In eight (53%) of the 15 eyes with active corneal epithelial defects at the time of lens fitting, the defects healed, whereas in the remaining seven eyes the corneal epithelial defects remained unchanged. Forty-five (92%) of the 49 patients reported improvement in their quality of life as a result of reduction of photophobia and discomfort. The mean wearing time of the gas-permeable scleral contact lenses was 13.7 hours per day (range, 4 to 18 hours). Many patients had preparatory surgical procedures before lens fitting (for example, punctal occlusion or mucous membrane grafting), and some had visual rehabilitation surgical procedures (for example, keratoplasty and/or cataract surgery) after lens fitting. Gas-permeable scleral contact lens wear provides an additional effective strategy in the surface management and visual rehabilitation of patients with severe ocular surface disease.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Indian J Ophthalmol
                Journal ID (iso-abbrev): Indian J Ophthalmol
                Journal ID (publisher-id): IJO
                Title: Indian Journal of Ophthalmology
                Publisher: Medknow Publications & Media Pvt Ltd (India )
                ISSN (Print): 0301-4738
                ISSN (Electronic): 1998-3689
                Publication date (Print): April 2017
                Volume: 65
                Issue: 4
                Pages: 320-322
                Affiliations
                [1]Narayana Nethralaya, Bengaluru, Karnataka, India
                Author notes
                Correspondence to: Mukesh Kumar, Narayana Nethralaya, 121/C, Chord Road, 1 st “R” Block, Rajaji Nagar, Bengaluru - 560 010, Karnataka, India. E-mail: mukesh.opt@ 123456gmail.com
                Article
                Publisher ID: IJO-65-320
                DOI: 10.4103/ijo.IJO_730_16
                PMC ID: 5452587
                PubMed ID: 28513499
                SO-VID: 44ecda30-3f4a-4e67-9620-99ac427523e1
                Copyright © Copyright: © 2017 Indian Journal of Ophthalmology
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

                History
                Date received : 19 September 2016
                Date accepted : 31 March 2017
                Categories
                Subject: Brief Communications

                ScienceOpen disciplines: Ophthalmology & Optometry
                Keywords: epithelial defects,mini-scleral lens,mucous membrane pemphigoid
                Data availability:
                ScienceOpen disciplines: Ophthalmology & Optometry
                Keywords: epithelial defects, mini-scleral lens, mucous membrane pemphigoid

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