[Immunology-related chronic progressive cicatricial conjunctival diseases: diagnosis, therapy and prognosis].
OBJECTIVE
We reviewed the records of patients with chronic cicatricial disease of the conjunctiva for differences in prognosis between clinical and histopathological subgroups of the disease and in therapeutic options.


METHODS
In 30 patients (58 eyes) with an average age of 69 years (52-86) chronic cicatricial disease of the conjunctiva was diagnosed clinically. Only in 22/30 patients conjunctival biopsies could be performed. The correlation of histopathological and immunohistochemical diagnoses with clinical course under systemic immunosuppression was studied.


RESULTS
15/22 biopsies led to a classification into different subgroups. Under systemic immunosuppression disease ceased to progress for a mean time of 15 months in 13 of 15 patients with positive biopsies and in 9 of 15 without classification. The results after cyclosporine A therapy (4 of 5 patients stabilized after a mean of 27.5 months) and mycophenolate mofetil (8 of 11 patients stabilized at a mean of 7.8 months) were better than those after therapy with dapsone, azathioprine and cyclophosphamide.


CONCLUSIONS
Histopathological and immunohistochemical examinations led to a classification in two-thirds of the patients with clinical aspects of chronic cicatricial disease of the conjunctiva. There was no correlation between different histopathological subgroups, success of therapy and prognosis of the disease. There is little hope in using new systemic immunosuppression such as cyclosporine A and mycophenolate mofetil.
Marx
W
W
Augenklinik der Heinrich-Heine-Universität, Moorenstrasse 5, 40225 Düsseldorf.
Reinhard
T
T
Megahed
M
M
Sundmacher
R
R
D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D003229:Conjunctival Diseases / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology; D016572:Cyclosporine / Q000627:therapeutic use; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007070:Immunoglobulin A / Q000032:analysis; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000031:analogs & derivatives* / Q000627:therapeutic use; D010391:Pemphigoid, Bullous / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology; D011379:Prognosis
D007070:Immunoglobulin A; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D009173:Mycophenolic Acid