Shantilal Shanghvi Cornea Institute, L V Prasad Eye Institute, Hyderabad, Telangana, India.
Ophthalmic Pathology Laboratory, L V Prasad Eye Institute, Hyderabad, Telangana, India; and.
Cornea. 2024 Feb 1;43(2):159-165. doi: 10.1097/ICO.0000000000003382. Epub 2023 Oct 3.
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).
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.
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).
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.
本研究旨在描述临床诊断为眼黏蛋白性口炎性类天疱疮（OMMP）患者的直接免疫荧光（DIF）发现及影响结膜活检阳性的因素。
本回顾性观察性病例系列纳入了 2018 年至 2021 年期间在机构环境中至少有 1 只眼行结膜活检进行 DIF 的临床疑似 OMMP 患者。主要结局指标是年龄和慢性眼部并发症与活检阳性的相关性。
在 61 例患者中，33 例（54.1%）临床疑似 OMMP 患者的 DIF 阳性。在 39 例行双侧活检的患者中，23 例（59%）阳性，其中 12 例（52%）双眼均阳性，11 例（48%）单眼阳性。在 22 例行单侧活检的患者中，10 例（45%）阳性。在 100 只活检眼中，45 只（45%）DIF 阳性。在所研究的免疫反应物中，所有 45 只阳性眼均可见 C3 线性沉积（100%）。年龄增长与活检阴性的可能性显著相关（P=0.032），而 Sotozono 慢性眼部并发症评分较高，提示疾病严重程度，与活检阳性的可能性较低（P=0.0042）和 DIF 上免疫反应物的总体表达较低（P=0.0007）相关。
年龄较大的患者和有更严重的眼表面疾病后遗症的患者可能出现 DIF 结果阴性。为了通过 DIF 优化确诊 OMMP 的机会，应在疾病早期对双眼进行活检。如果只对 1 只眼进行活检，必须选择受影响较小的眼。
