Increasing the diagnostic yield of conjunctival biopsy in patients with suspected ocular cicatricial pemphigoid.
BACKGROUND
Ocular cicatricial pemphigoid is a chronic, progressive, autoimmune disease that scars mucous membranes and may lead to blindness. It is of critical importance to be able to make the diagnosis as early as possible to allow early treatment. Conjunctival biopsy facilitates the early diagnosis of this condition.


METHODS
Conjunctival biopsy results of 166 consecutive patients seen over a 7-year period, in whom the diagnosis of ocular cicatricial pemphigoid was considered, were reviewed.


RESULTS
One hundred twenty-one patients ultimately received a diagnosis of ocular cicatricial pemphigoid. Immunofluorescence studies demonstrated characteristic deposition of immunoreactants at the epithelial basement membrane zone in 63 patients (sensitivity = 52%). When immunofluorescent-negative or inconclusive biopsies were processed further using an immunoperoxidase technique an additional 37 diagnoses were made. This represented an increase in sensitivity from 52% with immunofluorescence only to 83% with the addition of the immunoperoxidase technique.


CONCLUSIONS
The routine use of the immunoperoxidase technique in immunofluorescent-negative biopsies, allied with appropriate harvesting and handling of biopsied conjunctiva, should significantly increase the diagnostic yield in patients with clinically suspect ocular cicatricial pemphigoid.
Power
W J
WJ
Hilles Immunology Laboratory, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston 02114, USA.
Neves
R A
RA
Rodriguez
A
A
Dutt
J E
JE
Foster
C S
CS
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001327:Autoimmune Diseases / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D001485:Basement Membrane / Q000737:chemistry / Q000473:pathology; D001706:Biopsy; D002908:Chronic Disease; D003176:Complement C3 / Q000032:analysis; D003181:Complement C4 / Q000032:analysis; D003228:Conjunctiva / Q000473:pathology*; D003229:Conjunctival Diseases / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D005260:Female; D019084:Fluorescent Antibody Technique, Indirect; D006801:Humans; D007124:Immunoenzyme Techniques; D007136:Immunoglobulins / Q000032:analysis; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010390:Pemphigoid, Benign Mucous Membrane / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy
D003176:Complement C3; D003181:Complement C4; D007136:Immunoglobulins; D007166:Immunosuppressive Agents