title: Management of patients with confirmed and presumed mucous membrane pemphigoid undergoing entropion repair.
abstract: OBJECTIVE
  To describe the outcomes and medical management necessary to achieve successful lid surgery in patients with biopsy-confirmed and presumed mucous membrane pemphigoid.
  
  
  METHODS
  Retrospective, interventional case series.
  
  
  METHODS
  We included patients with positive biopsy results and cases with a typical clinical active bilateral presentation with negative biopsy results but classic features. We identified 11 operated eyes of 7 patients with lid malposition resulting from mucous membrane pemphigoid, particularly cicatricial entropion, that required surgical correction. Complete ophthalmologic history and examination were performed. The main outcome measures were control of ocular inflammation, progression of disease, and surgical success.
  
  
  RESULTS
  A bandage lens was used in 8 (72.7%) eyes to protect the cornea while immunosuppression and control of disease activity were achieved. Control of ocular inflammation before lid surgery was achieved in all cases. Immunosuppressive treatment before lid surgery was used in all cases for a mean of 15.1 months (range, 8.2 to 33.1 months) and after surgery for a mean of 6.6 months (range, 3.0 to 11.2 months). The oral immunosuppressive drugs used were mycophenolate and cyclophosphamide. Prednisone was used concomitantly in 4 (57%) patients. Full surgical success was achieved in all patients, with 1 patient requiring a second intervention because of residual disease. The mean postoperative follow-up period was 20.8 months (range, 6.0 to 30.5 months).
  
  
  CONCLUSIONS
  Successful entropion repair in patients with mucous membrane pemphigoid can be achieved if control of inflammation is attained before the procedure. Ocular surface protection while achieving disease control is essential in the management of these patients.
authors: Ocular Surface Center, Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida.
authors: Allister
authors: A
authors: Gibbons
authors: Division of Oculo-Plastic Surgery, Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida.
authors: Thomas E
authors: TE
authors: Johnson
authors: Division of Oculo-Plastic Surgery, Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida.
authors: Sara T
authors: ST
authors: Wester
authors: Ocular Surface Center, Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida.
authors: Astrid E
authors: AE
authors: Gonzalez
authors: Ocular Surface Center, Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida.
authors: Charles C
authors: CC
authors: Farias
authors: Ocular Surface Center, Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida.
authors: Carolina
authors: C
authors: Betancurt
authors: Ocular Surface Center, Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida.
authors: Guillermo
authors: G
authors: Amescua
authors: Ocular Surface Center, Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida. Electronic address: vperez4@med.miami.edu.
authors: Victor L
authors: VL
authors: Perez
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D003520:Cyclophosphamide / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D004774:Entropion / Q000601:surgery*; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D013508:Ophthalmologic Surgical Procedures; D010390:Pemphigoid, Benign Mucous Membrane / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D012189:Retrospective Studies; D013536:Suture Techniques; D014792:Visual Acuity / Q000502:physiology
chemical_list: D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D003520:Cyclophosphamide; D009173:Mycophenolic Acid