Purpose

Managing glaucoma alongside cicatrising ocular surface disease (OSD) is uniquely challenging as topical glaucoma medications may exacerbate OSD and filtration surgery risks disease reactivation, whilst topical corticosteroids worsen glaucoma. This report describes treatment patterns and the temporal relationship between cicatricial OSD and glaucoma in a tertiary centre.

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Methods

Retrospective study of 31 patients with concurrent cicatrising OSD and glaucoma. Diagnoses, intraocular pressure (IOP), immunotherapy, and surgical interventions were recorded.

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Results

Median age 89 years (IQR 79.5–95.5); 16F:15M. Median follow-up 8.4 years (IQR 4.3–11.4). OSD diagnoses: ocular mucous membrane pemphigoid [OcMMP] (n=21, 67.7%), drug-induced cicatrisation [DIC] (n=4, 12.9%), pemphigus (n=3, 9.7%), trachoma (n=2, 6.5%), blepharokeratoconjunctivitis [BKC] (n=1, 3.2%). Glaucoma subtypes: primary open angle glaucoma (POAG, n=20, 37.0%), ocular hypertension (n=17, 31.5%), secondary to topical treatment (n=10, 18.5%), closed angle (n=2, 3.7%). OSD preceded glaucoma in 22 patients (71.0%; median 13.8 months, IQR 7.1–41.0); glaucoma preceded OSD in 9 (29.0%; median 42.3 months, IQR 19.5–69.1). Immunosuppression was required for 21 OcMMP patients: mycophenolate (n=12), azathioprine (n=4), dapsone (n=3), methotrexate (n=1). Mean IOP fell from 25.9 to 14.3 mmHg from diagnosis to last follow-up. Alternatives to topical glaucoma therapy were used in 12 eyes (22.2%). Laser trabeculoplasty in 1 eye, istent in 9 eyes (including 4 Ocmmp eyes), a trabeculectomy and Baerveldt Tube in each eye of a patient with DIC.

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Conclusion

OSD preceded glaucoma in 71.0%, largely apportioned to OcMMP. About two thirds of patients had adequately controlled glaucoma on topical treatment alone. Trabecular bypass with iStent was the most common surgical intervention, being relatively conjunctiva-sparing. No bleb filtration surgery was required in any OcMMP patient. As these patients attend appointments for both OSD and glaucoma, increased monitoring may be associated with a lower likelihood of requiring surgery.

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Additional Authors

First name	Last name	Base Hospital / Institution
Aden	Yin Tong Siu	Birmingham and Midlands Eye Center
Gibran	Butt	Birmingham and Midlands Eye Center
Saaeha	Rauz	Birmingham and Midlands Eye Center

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