Jornal de Oftalmologia Clínica e Experimental
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Optimizing Treatment Outcomes for Ocular Mucous Membrane Pemphigoid

Ryan C Teeple, Linda Hynan and H. Dwight Cavanagh

Purpose: To evaluate the change in best corrected visual acuity over time for patients with ocular mucous membrane pemphigoid (MMP) and to compare the effectiveness of various immunosuppressive treatments in preserving vision.
Design: Retrospective chart review. Outcome measures: The principal outcome measures assessed were: improvement in vision, no change in vision or a decrease in vision.
Methods: All patients diagnosed with ocular cicatricial pemphigoid or mucous membrane pemphigoid at UT Southwestern Medical Center in Dallas, Texas from 2003 to 2012 were identified and their charts reviewed.
Results: 29 patients and 57 eyes were included in the study. 22 of the patients had positive biopsies. The average age of the patients was 67 years old. The average follow-up was 49 months (range 6–143 months). More than half (15 of 29 patients) required a change in therapy and one patient had their treatment changed seven times. When used as first drug therapy, the percent of eyes that had either no change or an actual improvement in vision over the course of that treatment was 83% (10 of 12 eyes) for Mycophenolate, 69% (22 of 32 eyes) for Dapsone, and 60% (6 of 10 eyes) for Cyclophosphamide. When second drug therapy was necessary, the percent of eyes that had either no change or an improvement in vision over the course of that treatment was 75% (3 of 4 eyes) for Rituximab, 64% (9 of 14 eyes) for Azathioprine, 50% (4 of 8 eyes) for Mycophenolate, and 25% (1 of 4 eyes) for Dapsone. Looking at all outcomes without regard to the stage of treatment, 90% of eyes (9 of 10) treated with Rituximab had either no change or an improvement in vision over the course of their treatment.
Conclusions: MMP is a blinding disease which can respond to aggressive and compliant long-term treatment. Newer therapies show promise; in this series Rituximab was found to provide the best results in preserving vision.