Conjunctival Biopsy Site in Mucous Membrane Pemphigoid

Coco, Giulia; Romano, Vito; Menassa, Nardine; Borroni, Davide; Iselin, Katja; Finn, Daniel J.; Figueiredo, Gustavo S.; Tacea, Filofteia; Field, E A; Ahmad, Sajjad; Kaye, Stephen B.

doi:10.1016/j.ajo.2020.01.033

Cited by 6 publications

(9 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The presence of either one of the above on DIF is considered as a positive biopsy, although the panel of immunoreactants studied has differed among studies. 1 , 4 , 15 The sensitivity of DIF also varies, ranging from 30% to 80%. 4 , 23 IgG has been found to be the most common positive immunoreactant, 4 , 24 , 25 whereas linear deposition of IgA or IgG along the basement membrane is deemed to be most sensitive for diagnosis of MMP.…”

Section: Discussionmentioning

confidence: 99%

“… 1 , 4 , 15 The sensitivity of DIF also varies, ranging from 30% to 80%. 4 , 23 IgG has been found to be the most common positive immunoreactant, 4 , 24 , 25 whereas linear deposition of IgA or IgG along the basement membrane is deemed to be most sensitive for diagnosis of MMP. 26 Combined IgG and IgA is found in more severe disease.…”

Section: Discussionmentioning

confidence: 99%

“…Biopsy was not performed from sites of conjunctival scarring or symblepharon or the fornix. 4 , 5 The excised conjunctival tissue was divided into 2 equal sections. The tissue was sent for both histopathologic examination and DIF examination.…”

Section: Methodsmentioning

confidence: 99%

“…Although the oral mucosa is the most commonly involved site, [1][2][3] the conjunctiva is involved in around 70% of all patients with MMP and presents as bilateral chronic cicatrizing conjunctivitis (CCC) that can eventually lead to blindness due to corneal scarring, neovascularization, and surface keratinization. 2,4,5 Although ocular MMP is the most common cause of CCC in developed countries, 2,6,7 CCC can also occur due to other etiologies such as drug-induced cicatrizing conjunctivitis, Stevens-Johnson syndrome, and atopic keratoconjunctivitis. 8,9 Various other causes of CCC and MMP share similar clinical features, but it is important to distinguish these conditions to arrive at the correct etiological diagnosis.…”

mentioning

confidence: 99%

See 3 more Smart Citations

Direct Immunofluorescence Findings and Factors Affecting Conjunctival Biopsy Positivity in Ocular Mucous Membrane Pemphigoid

Jain,

Jakati,

Shanbhag

et al. 2023

Cornea

View full text Add to dashboard Cite

Purpose: The aim of this study was to describe the direct immunofluorescence (DIF) findings and factors affecting conjunctival biopsy positivity in patients clinically diagnosed with ocular mucous membrane pemphigoid (OMMP). Methods: This retrospective observational case series included patients with clinical OMMP who underwent conjunctival biopsy for DIF in at least 1 eye between 2018 and 2021 in an institutional setting. The primary outcome measures were association of age and chronic ocular complications with biopsy positivity. Results: Of 61 patients, DIF positivity was seen in 33 (54.1%) clinically suspected cases of OMMP. Of 39 patients who underwent bilateral biopsy, 23 (59%) were positive, of which 12 (52%) were positive in both eyes while 11 (48%) were positive in 1 eye. Of 22 patients who underwent unilateral biopsy, 10 (45%) were positive. Of the 100 biopsied eyes, 45 (45%) were DIF positive. Among the immunoreactants studied, linear deposition of C3 was seen in all 45 positive eyes (100%). Increasing age was significantly associated with higher likelihood of biopsy negativity (P = 0.032), whereas a greater Sotozono chronic ocular complication score, indicative of disease severity, was associated with low likelihood of biopsy positivity (P = 0.0042) and lower overall expression of immunoreactants on DIF (P = 0.0007). Conclusions: Older patients and patients with more severe ocular surface disease sequelae are likely to have negative DIF results. To optimize the chances of confirming the diagnosis of OMMP by DIF, both eyes should be biopsied early in the disease course. If 1 eye is being biopsied, the less affected eye must be chosen.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Direct Immunofluorescence Findings and Factors Affecting Conjunctival Biopsy Positivity in Ocular Mucous Membrane Pemphigoid

Jain,

Jakati,

Shanbhag

et al. 2023

Cornea

View full text Add to dashboard Cite

show abstract

“…In patients with suspected ocular monosite MMP direct immuno-fluorescence (DIF) on conjunctival biopsy, is the most sensitive method for diagnosis and is the gold standard investigation; a positive indirect immunofluorescence is less sensitive but also specific and confirms the diagnosis in patients with a negative DIF findings from ocular or other sites. Perilesional conjunctival biopsies (taken from noninflamed conjunctiva when possible) are associated with an increased positive DIF result compared to lesional or nonaffected conjunctival biopsies [8 ▪▪ ]. On of the difficulties in the diagnosis on monosite OMMP is that these tests are negative in 50% of cases [7,9 ▪▪ ].…”

Section: Introductionmentioning

confidence: 99%

Ocular mucous membrane pemphigoid: novel treatment strategies

Jabbour

Phylactou

Ahmad

2021

Current Opinion in Allergy &Amp; Clinical Immunology

Self Cite

View full text Add to dashboard Cite

Purpose of reviewTo describe current treatments of ocular mucous membrane pemphigoid (OMMP), including conventional systemic immunosuppression (CIST) and novel biologic agents.Recent findingsCIST remains the main stay therapy for the management of OMMP. The choice of agents is tailored to disease severity – mild disease is treated with dapsone, whereas moderately severe cases are often treated with mycophenolate mofetil or sulfa-based drugs and severe cases are treated with cyclophosphamide. In recalcitrant disease newer biologics such as Rituximab, intravenous immunoglobins and tumour necrosis alpha antagonists have proven to be effective in disease control. Control of inflammation with topical therapy and halting conjunctival fibrosis remain as areas of unmet clinical needs.SummaryOMMP is largely treated with CIST. The recent introduction of new biologic agents could shape the way the disease is treated in the near future.

show abstract