Mucous Membrane Pemphigoid with Ocular Involvement

Ong, Hon Shing; Setterfield, Jane; Minassian, Darwin; Dart, John; Booth, Debbie; Reid, Elaina; Carnt, Nicole; Gugliemetti, Stefano; Shanmuganathan, Vijay; Watson, Martin M.; Saw, Valerie P J; Wilkins, Mark R; McCudden, Vicky; Ahmad, Saj; Calder, Virginia L.; Waseem, Naushin; Scott, Beverly; Bunce, Catey; Gage, William H.; Gleeson, Mike; Lund, Valerie J.; Sandhu, Guri

doi:10.1016/j.ophtha.2017.10.004

Cited by 57 publications

(49 citation statements)

References 32 publications

(27 reference statements)

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“…Indeed, the Mucous Membrane Pemphigoid Study Group recommends that patients having clinical signs of OCP with negative biopsy should be considered as direct-immunofluorescencenegative OCP [6].…”

Section: Discussionmentioning

confidence: 99%

Amniotic Membrane Graft in Ocular Cicatricial Pemphigus: A More Conservative Approach

Chraïbi

2020

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Purpose: To report more conservative management of ocular cicatricial pemphigus (OCP) lesions by performing an initial corneal partial amniotic membrane graft without disturbance of the inflamed conjunctiva. Methods: A case report of a patient having a stage 3 OCP in his left eye with a corneal ulcer. He was managed by partial corneal amniotic membrane (AM) graft. Results: The course was favorable with complete corneal ulcer healing and incidentally there was an important regression of associated ocular surface inflammatory signs with a less prominent inferior symblepharon strand. Conclusion: We propose to manage newly diagnosed patients having advanced ocular cicatricial pemphigus disease with partial corneal amniotic membrane graft before performing radical adnexal surgery with prior immunosuppressive treatment.

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Section: Discussionmentioning

confidence: 99%

Amniotic Membrane Graft in Ocular Cicatricial Pemphigus: A More Conservative Approach

Chraïbi

2020

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“…17 The CC was classified as severe if it involved 5 mm of the central cornea (pupillary area) with neo-vessels, scarring, ulceration, conjunctivalization or keratinization. 19 All patients underwent an initial exploration under a slit lamp of the ocular surface, cornea and fundus in pharmacological dilatation. The BCVA (Better Corrected Visual Acuity), IOP (intraocular pressure) was measured with Goldmann tonometer, the Tear Breakup time (TBUT) was measured in seconds and using fluorescein as staining, and the Schirmer I test was also performed and measured in millimetres for 5 minutes, these evaluations were carried out at the beginning and each follow-up visit.…”

Section: Methodsmentioning

confidence: 99%

<p>Plasma Rich in Growth Factors for the Treatment of Cicatrizing Conjunctivitis</p>

Montero-Iruzubieta¹,

Sánchez-Ávila

Orive

et al. 2020

OPTH

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The objective was to evaluate the clinical results obtained from the use of immunosafe plasma rich in growth factors (isPRGF) in the treatment of patients with cicatrizing conjunctivitis (CC) who had not responded to the usual therapy. Patients and Methods: This is a retrospective study that included patients diagnosed with CC, in whom isPRGF was used in different phases (I: eye drops; II: eye drops and injectable; III: eye drops, injectable and surgical treatment) to achieve control of the inflammation. As a clinical follow-up of the patients, the better corrected visual acuity (BCVA), degree of inflammation (measured from 1 to 4), the severity of the CC, Schirmer I test, IOP and TBUT were analyzed. The adverse events were also evaluated. Results: Ten eyes (6 patients) were evaluated, 50% corresponded to Stevens-Johnson Syndrome and 50% to ocular mucous membrane pemphigoid. The mean age was 59.7 ± 16.5 (39-80) years, and 50% were women. Fifty per cent of the cases were initially considered severe CC, and 10% of the cases (one eye of one patient) were considered severe CC at the end of the treatment (p = 0.046). The initial degree of inflammation was 2 in 4 eyes, 3 in two eyes, and 4 in 4 eyes, and final inflammation degree was 1 in all cases (p = 0.004). Twenty per cent of the cases achieved stability in Phase I of the treatment with immunosafe PRGF, 70% with both Phases I and II, and only one case underwent Phase III to achieve stability. The IOP improved significantly (p = 0.027) though the BCVA, TBUT and Schirmer I test showed no significant changes. The follow-up time was 23.1 ± 6.7 (13.6-30.3) months. No adverse effects were reported. Conclusion: Treatment with PRGF technology in its injectable and topical immunosafe formulations may be a novel alternative for the treatment of patients with CC, given its complement activity modulating effect, as well as its anti-inflammatory, antifibrotic and regenerative properties.

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“…The international consensus has documented that the clinical findings of mucosa-dominant lesions and DIF detecting tissue-bound IgG, IgA, and/or C3 are essential for the diagnosis (1). Several studies have followed this criteria (41, 44, 51). We also fundamentally agree with the criteria and have introduced it in our studies.…”

Section: Issues In Diagnosing Mmpmentioning

confidence: 99%

The Diagnosis and Blistering Mechanisms of Mucous Membrane Pemphigoid

Kamaguchi

Iwata

2019

Front. Immunol.

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Mucous membrane pemphigoid (MMP) is a mucous membrane-dominated autoimmune subepithelial blistering disease that is caused by autoantibodies against various autoantigens in basement membrane zone (BMZ) proteins, including collagen XVII (COL17). Clinicians face diagnostic problems in detecting circulating antibodies and targeted antigens in MMP. The diagnostic difficulties are mainly attributed to the low titers of MMP autoantibodies in sera and to heterogeneous autoantigens. Additionally, no unanimous diagnostic criteria have been drawn for MMP, which can result in delayed diagnoses or misdiagnoses. This review aims to integrate and present currently available data to clarify diagnostic strategies and to present diagnostic criteria for MMP. The ultimate blistering mechanism in MMP has not been elucidated, and such mechanism is especially obscure in COL17-type MMP. In bullous pemphigoid (BP), which is the most common autoimmune subepidermal blistering disease, some patients show oral lesion as well as predominant skin lesions. However, there is no fundamental explanation for the onset of oral lesions in BP. This article summarizes innovative research perspectives on the pathogenesis of oral lesions in pemphigoid. Finally, we propose a potential pathogenesis for COL17-type MMP.

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Mucous Membrane Pemphigoid with Ocular Involvement

Cited by 57 publications

References 32 publications

Amniotic Membrane Graft in Ocular Cicatricial Pemphigus: A More Conservative Approach

Amniotic Membrane Graft in Ocular Cicatricial Pemphigus: A More Conservative Approach

<p>Plasma Rich in Growth Factors for the Treatment of Cicatrizing Conjunctivitis</p>

The Diagnosis and Blistering Mechanisms of Mucous Membrane Pemphigoid

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