Transcript 266: Long-Term Management of Ocular Disease in Laryngo

Long term management
of ocular disease in
Laryngo-Onycho-Cutaneous syndrome
A Kadyan, A Aralikatti, J Newton-Bishop, S Shah
Birmingham and Midland Eye Centre, UK
The authors have no financial interest in the subject matter of this poster
Purpose
• To describe the management and outcomes of ocular surface
reconstruction and anti-tumour necrosis factor alpha agents
(Infliximab) in patients with LOC.
Methods
• Four children (3 females and one male) underwent multiple
procedures involving excision of ocular granulation tissue and
ocular surface reconstruction using amniotic membrane grafts
(AMG).
• Infliximab was added last 24 months and the benefits of
surgery with and without Infliximab were assessed.
• Average follow up: 6 years ± 2.2 SD (range 4 to 9 years).
Results
• Granulation tissue recurred at average 8 months ± 3.7 SD
(range: 4-17 months) prior to Infliximab
• Infliximab infusions appeared to reduce inflammation and
vascularisation with delayed and limited recurrence of
granulation tissue.
• Frequency of surgery was however not significantly affected
• 2 patients transiently withdrew treatment with Infliximab
resulting in rapid exacerbations with more aggressive
granulation tissue
Example Case 3
Preoperative images of right and left eye (4A & B),
Regressed avascular granulation tissue following Infliximab therapy (4C & D),
Aggressive recurrence on Infliximab withdrawal (4E),
postoperative residual corneal scar (4F)
Example Case 4
Early immunosuppression has reduced need for frequent surgery &
prevented corneal encroachment
Conclusion
• Ocular disease in LOC can be successfully managed with
immunomodulation and ocular surface reconstruction
• Better visual outcomes may be achieved with early initiation
of immunomodulation.
• Longer review will be needed to assess safety and continued
benefit of Infliximab therapy