Faculty of Medicine, McGill University, Montréal, Canada.
Ophthalmology department, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Canada.
Eur J Ophthalmol. 2024 Jan;34(1):112-118. doi: 10.1177/11206721231178110. Epub 2023 May 24.
To evaluate preferred diagnostic tools and treatment decision-making factors in cases suspicious of mucous membrane pemphigoid (MMP) amongst ophthalmologists and cornea specialists.
Web-based survey, consisting of 14 multiple choice questions, posted to the Cornea Society Listserv Keranet, the Canadian Ophthalmological Society Cornea Listserv, and the Bowman Club Listserv.
One hundred and thirty-eight ophthalmologists participated in the survey. Eighty-six percent (86%) of respondents were cornea trained and practiced in either North America or Europe (83%). Most respondents (72%) routinely perform conjunctival biopsies for all suspicious cases of MMP. For those who do not, fear that biopsy will exacerbate inflammation was the most common reason to defer investigation (47%). Seventy-one percent (71%) performed biopsies from perilesional sites. Ninety-seven percent (97%) ask for direct (DIF) studies and 60% for histopathology in formalin. Most do not recommend biopsy at other non-ocular sites (75%), nor do they perform indirect immunofluorescence for serum autoantibodies (68%). Immune-modulatory therapy is started following positive biopsy results for most (66%), albeit most (62%) would not let a negative DIF influence the choice of starting treatment should there be clinical suspicion of MMP. Differences in practice patterns as they relate to level of experience and geographical location are contrasted to the most up-to-date available guidelines.
Responses to the survey suggest that there is heterogeneity in certain practice patterns for MMP. Biopsy remains an area of controversy in dictating treatment plans. Identified areas of need should be targeted in future research.
评估眼科医生和角膜专家在疑似黏膜性类天疱疮（MMP）病例中首选的诊断工具和治疗决策因素。
采用网络问卷调查，向角膜学会 Keranet 列表、加拿大眼科学会角膜列表和 Bowman 俱乐部列表发布了包含 14 个多项选择题的调查。
138 名眼科医生参与了这项调查。86%（86%）的受访者接受过角膜培训，并在北美或欧洲行医（83%）。大多数受访者（72%）对所有疑似 MMP 病例常规进行结膜活检。对于那些不进行活检的人，担心活检会加重炎症是最常见的推迟检查的原因（47%）。71%（71%）在病变周围部位进行活检。97%（97%）要求进行直接免疫荧光（DIF）研究，60%在福尔马林固定时进行组织病理学检查。大多数人不建议在其他非眼部部位进行活检（75%），也不建议进行血清自身抗体的间接免疫荧光检查（68%）。大多数人在活检结果阳性后开始进行免疫调节治疗（66%），尽管大多数人（62%）认为如果临床怀疑 MMP，即使 DIF 阴性也不会影响开始治疗的选择。根据经验水平和地理位置的不同，实践模式的差异与最新的可用指南形成对比。
调查结果表明，在 MMP 的某些治疗模式方面存在异质性。活检在决定治疗方案方面仍然存在争议。需要针对确定的领域开展未来的研究。
