Reliability of Conjunctival Biopsy for Diagnosis of Ocular Mucous Membrane Pemphigoid: Redetermination of the Standard for Diagnosis and Outcomes of Previously Biopsy-Negative Patients

ABSTRACT

Purpose: To demonstrate the reliability of conjunctival biopsy analyzed by direct immunofluorescence (DIF) and supplemented with avidin-biotin complex immunoperoxidase (ABC) in diagnosing oMMP, and report therapy response in biopsy-positive patients, particularly when previously biopsy-negative elsewhere.

Methods: Retrospective outcomes review of 136 consecutive patients after conjunctival biopsy for suspected oMMP.

Results: Among 136 patients, 66% were diagnosed with oMMP by DIF and 13% via supplemental ABC immunoperoxidase. Sensitivity increased from 79.6% with DIF to 95.6% with supplemental ABC. Among 57 biopsy-positive patients, 77% were in remission at 1-year follow-up and 88% after 2 years. Of 34 previous biopsy-negative but now biopsy-positive patients with a 2-year follow-up, 91% achieved remission, including all 16 diagnosed via DIF and ABC.

Conclusion: Conjunctival biopsy analyzed by histopathology and DIF supplemented by ABC has high reliability for diagnosing oMMP and is a useful tool to use before starting long-term immunomodulatory therapy in a patient with suspected oMMP.

KEYWORDS:

• Ocular cicatricial pemphigoid
• immunoperoxidase
• biopsy
• ocular inflammatory disease
• conjunctiva
• ocular surface
• inflammation
• immunology
• diagnostic tests
• mucous membrane pemphigoid

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Direct Immunofluorescence Findings in 145 Consecutive Patients Receiving a Conjunctival Biopsy for Cicatrizing Conjunctivitis

Acknowledgments

All authors have reviewed and agree to all revisions made to this paper.

Data availability statement

The data that supports the findings of this study are available from the corresponding author, CSF, upon reasonable request.

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

Financial disclosures

Dr. C Stephen Foster declares the following:

Consultancies with Aldeyra Therapeutics (Lexington, MA), Allakos (Redwood City, CA), Bausch & Lomb Surgical, Inc (Rancho Cucamonga, CA), Eyegate Pharma (Waltham, MA), Genentech (South San Francisco, CA), Novartis (Cambridge, MA), pSivida (Watertown, MA)

Grants or grants pending with Aciont (Salt Lake City, UT), Alcon (Aliso Viejo, CA), Aldeyra Therapeutics (Lexington, MA), Bausch & Lomb (Rochester, NY), Clearside Biomedical (Alpharetta, GA), Dompé pharmaceutical (Milan, Italy), Eyegate Pharma (Waltham, MA), Mallinckrodt pharmaceuticals (Staines-upon-Thames, UK), Novartis Pharmaceuticals (Cambridge, MA), pSivida (Watertown, MA), Santen (Osaka, Japan)

Payment for lectures including service on speaking bureaus: Alcon (Aliso Viejo, CA), Allergan (Dublin, Ireland), Mallinckrodt pharmaceuticals (Staines-upon-Thames, UK)

Stock or Stock Options: Eyegate Pharma (Waltham, MA)

Dr. Stephen D. Anesi declares the following:

Consultancies with Santen (Osaka, Japan), Mallinckrodt (Staines-upon-Thames, UK), Allakos (Redwood City, CA), Eyepoint (Watertown, MA), and Takeda (Tokyo, Japan).

Speakerships with AbbVie (Chicago, IL), Mallinckrodt (Staines-upon-Thames, UK), and Eyepoint (Watertown, MA).

All other authors have no proprietary or commercial interest in any materials discussed in this article or additional financial disclosures to declare.

Additional information

Funding

No government or non-government funding were used in the study.