Cicatricial changes in ocular pemphigus.
OBJECTIVE
To describe the clinical characteristics of ocular involvement in patients with pemphigus at an ophthalmological referral center.


METHODS
A retrospective review was conducted on patients with the immunopathological diagnosis of pemphigus examined between 1 January 2000 and 1 April 2010. Uncorrected distance visual acuity (UDVA), best corrected distance visual acuity (BCVA), ocular symptoms, and ocular surface inflammatory and scarring changes were assessed.


RESULTS
A total of 15 patients were identified, with a mean age of 68.27 ± 14.35 years, and 80% (n=12) were female. Extraocular involvement was reported in one patient. All of the eyes showed cicatricial changes in the conjunctiva. In all, 6 eyes (20%) were classified as stage I; 12 eyes (40%) as stage II; 10 eyes (33%) as stage III; and 2 eyes (7%) as stage IV. A statistically significant association was found between BCVA and the severity of ocular involvement. The mean BCVA logMAR was 1.66 (20/914), with a range from logMAR 0 (20/20) to logMAR 4 (NLP). Other ocular diseases were found in 8 (53.3%), systemic diseases in 10 (66.7%), and the use of pemphigus-inducing drugs in 10 patients (66.7%).


CONCLUSIONS
The present report represents the largest series of ocular involvement in pemphigus confirmed by immunopathology. The clinical manifestations varied from conjunctival hyperemia to corneal scarring and perforation. There was a strong association between scarring changes and low BCVA. Ocular and systemic diseases as well as the use of pemphigus-inducing drugs may predispose to ocular cicatricial changes observed in this series.
Cornea and Refractive Surgery Department, Institute of Ophthalmology 'Fundación de Asistencia Privada Conde de Valenciana', Mexico City, Mexico.
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Chirinos-Saldaña
Cornea and Refractive Surgery Department, Institute of Ophthalmology 'Fundación de Asistencia Privada Conde de Valenciana', Mexico City, Mexico.
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Zuñiga-Gonzalez
Cornea and Refractive Surgery Department, Institute of Ophthalmology 'Fundación de Asistencia Privada Conde de Valenciana', Mexico City, Mexico.
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JC
Hernandez-Camarena
Cornea and Refractive Surgery Department, Institute of Ophthalmology 'Fundación de Asistencia Privada Conde de Valenciana', Mexico City, Mexico.
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Navas
Cornea and Refractive Surgery Department, Institute of Ophthalmology 'Fundación de Asistencia Privada Conde de Valenciana', Mexico City, Mexico.
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T
Ramirez-Luquin
Immunology Department, Research Unit Institute, Institute of Ophthalmology 'Fundación de Asistencia Privada Conde de Valenciana', Mexico City, Mexico.
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Robles-Contreras
1] Immunology Department, Research Unit Institute, Institute of Ophthalmology 'Fundación de Asistencia Privada Conde de Valenciana', Mexico City, Mexico [2] Immunology Lab, Department of Biochemistry, Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico.
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Jimenez-Martinez
Cornea and Refractive Surgery Department, Institute of Ophthalmology 'Fundación de Asistencia Privada Conde de Valenciana', Mexico City, Mexico.
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Ramirez-Miranda
Microbiology and Ocular Proteomics Department, Research Unit, Institute of Ophthalmology 'Fundación de Asistencia Privada Conde de Valenciana', Mexico City, Mexico.
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Bautista-de Lucio
Cornea and Refractive Surgery Department, Institute of Ophthalmology 'Fundación de Asistencia Privada Conde de Valenciana', Mexico City, Mexico.
E O
EO
Graue-Hernandez
D000368:Aged; D000369:Aged, 80 and over; D002921:Cicatrix / Q000473:pathology*; D003229:Conjunctival Diseases / Q000188:drug therapy / Q000209:etiology / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010392:Pemphigus / Q000150:complications / Q000188:drug therapy / Q000473:pathology*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014792:Visual Acuity
D007166:Immunosuppressive Agents