Ocular cicatricial pemphigoid secondary to intravitreal implant of ranibizumab: a case report

Abstract

Purpose Mucous membrane pemphigoid is a systemic disorder that primarily affects mucous membranes. When localized to conjunctiva, it is know as ocular cicatricial pemphigoid (OCP), a potentially blinding desease resulting in progressive conjunctival fibrosis and ocular surface failure.Women are affected more than men by a ratio of 8:1. Age on onset is usually age 60 to 80 and rarely younger than 30. We describe the case of a patient with OCP secondary to intravitreal implant of ranibizumab. Methods We describe the case of a patient with OCP secondary to intravitreal implant of ranibizumab. Results A 85 years old woman with bilateral macular degeneration, treated with intravitreal implants of ranibizumab in the right eye, began with a non specific queratoconjunctivitis in the right eye after the second administration of intravitreal ranibizumab. In numerous ophthalmology follow‐ up appointments the patient presented red right eye and increased amount of tears. Six months later, after another intravitreal implant of ranibizumab, the patient presented a subepithelial fibrosis, as fine gray‐white striae in the inferior fornix. The patient was treated with topic corticosteroid, cyclosporin 0,2%, autologous serum eye 20% with a significant improvement. A systemic treatment with 15 mg methotrexate once a week and the suspension of intravitreal implants of ranibizumab was necessary to control the progression of the OCP. Conclusions In some patients, systemic drugs (practolol, D penicilamine…), have triggered the onset of OCP. The term pseudopemphigoid or drug‐induced pemphigoid may be used to describe these cases. There are not cases of POC secondary to ranibizumab described on the literature.