title: Role of electron microscopy in the diagnosis of ocular mucous membrane pemphigoid.
abstract: OBJECTIVE
  To evaluate the role of electron microscopy (EM) for the diagnosis of ocular mucous membrane pemphigoid (MMP) among patients with cicatrizing conjunctivitis.
  
  
  METHODS
  Retrospective case series.
  
  
  METHODS
  One hundred twenty-eight patients with cicatrizing conjunctivitis referred for the evaluation of possible ocular MMP between January 1985 and February 2002 who underwent conjunctival biopsy and evaluation with EM and direct immunofluorescent (DIF) techniques.
  
  
  METHODS
  The diagnosis of each patient was based on DIF techniques. The reproducibility of EM readings was measured by assessing intraobserver and interobserver variability. The diagnosis from EM was compared to the DIF diagnosis from the same patient to evaluate the validity of the EM diagnosis.
  
  
  METHODS
  Sensitivity, specificity, positive predictive value, and negative predictive value of EM for diagnosing ocular MMP.
  
  
  RESULTS
  One hundred twenty-six of 128 conjunctival biopsies were available for evaluation of EM findings. The percent agreement between 2 readings from the same observer was 92%, and the percent agreement between 2 independent observers was 78%. The sensitivity and specificity of EM for the diagnosis of ocular MMP were 51% and 72%, respectively. The positive predictive value of EM for the diagnosis of ocular MMP was 49%.
  
  
  CONCLUSIONS
  The reproducibility of EM findings was good as indicated by high percent agreement for both intraobserver and interobserver measurements. However, the sensitivity, specificity, and positive predictive value of EM for the diagnosis of ocular MMP was low. It seems that EM has limited usefulness in the diagnosis of ocular MMP.
authors.affiliation: Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, USA. jthorne@jhmi.edu
authors.forename: Jennifer E
authors.initials: JE
authors.lastname: Thorne
authors.forename: Grant J
authors.initials: GJ
authors.lastname: Anhalt
authors.forename: Douglas A
authors.initials: DA
authors.lastname: Jabs
authors.forename: Zenaida
authors.initials: Z
authors.lastname: de la Cruz
authors.forename: W Richard
authors.initials: WR
authors.lastname: Green
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001327:Autoimmune Diseases / Q000175:diagnosis*; D001485:Basement Membrane / Q000648:ultrastructure; D001706:Biopsy; D002648:Child; D003228:Conjunctiva / Q000648:ultrastructure*; D003231:Conjunctivitis / Q000175:diagnosis*; D005189:False Positive Reactions; D005260:Female; D019085:Fluorescent Antibody Technique, Direct; D006801:Humans; D008297:Male; D008854:Microscopy, Electron; D008875:Middle Aged; D015588:Observer Variation; D010390:Pemphigoid, Benign Mucous Membrane / Q000175:diagnosis*; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity