THE VALUE OF BIOPSIES IN THE EVALUATION OF CHRONIC PROGRESSIVE CONJUNCTIVAL CICATRIZATION

Background: Chronic progressive conjunctival cicatrisation is poorly u nderstood, and therapy of this condition remains difficult. This study assessed the value of immunohistochemical investigations in the evalu ation of patients who present with chronic cicatrising conjunctivitis similar to cicatricial pemphigoid (CP) Methods: Bulbar conjunctival bi opsies from 36 patients with acute (n = 5), subacute (n = 13) and chro nic (n = 18) ocular disease were studied. The biopsy was retaken in 7 patients to evaluate the present immunological findings in comparison with a biopsy more then 5 years ago. All the specimens were investigat ed for the presence of immunoglobulins and complement at the epithelia l basement membrane, and the phenotype of the inflammatory cellular in filtrate was analysed. Twenty-nine patients were evaluated for the pre sence of circulating IgG-anti-basement membrane zone antibodies Result s: CP was confirmed by immunoglobulins and/or complement deposition al the epithelial basement membrane in 11 patients (31 %). IgA was found to be the most frequent deposit. Eleven CP patients, mainly those wit h active or ''burnt-out'' disease, showed absence of immunoglobulins a nd/or complement at the conjunctival basement membrane. In 14 of 36 pa tients, conjunctival cicatrisation was subsequently felt to be caused by conditions other than CP. The cellular phenotype in the subepitheli al conjunctiva was unspecific, but in CP the disease activity was refl ected by the number of neutrophils and macrophages. Circulating IgG an tibodies were found in none of the patients' serum Conclusion: Immunog lobulin and/or complement deposition at the epithelial basement membra ne confirms the diagnosis of mucous membrane pemphigoid. Their absence , however, does not rule it out and is a frequent feature in very acti ve conjunctival disease or after immunosuppressive treatment. The anal ysis of the cellular phenotype in mucous membrane pemphigoid may be us eful in the assessment of disease activity but does not help in determ ining the underlying disease process causing the cicatrising conjuncti vitis