Diagnosis, therapy and prognosis of chronic cicatricial disease of the conjunctiva

Purpose. We reviewed the records of patients with chronic cicatricial disea se of the conjunctiva for differences in prognosis between clinical and his topathological subgroups of the disease and in therapeutic options. Patients. In 30 patients (58 eyes) with an average age of 69 years (52-86) chronic cicatricial disease of the conjunctiva was diagnosed clinically. On ly in 22/30 patients conjunctival biopsies could be performed. The correlat ion of histopathological and immunohistochemical diagnoses with clinical co urse under systemic immunosuppression was studied. Results. 15/22 biopsies led to a classification into different subgroups. U nder systemic immunosuppression disease ceased to progress fora mean time o f 15 months in 13 of 15 patients with positive biopsies and in 9 of 15 with out classification. The results after cyclosporine A therapy (4 of 5 patien ts 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 afte r 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 chr onic cicatricial disease of the conjunctiva. There was no correlation betwe en different histopathological subgroups, success of therapy and prognosis of the disease. There is little hope in using new systemic immunosuppressio n such as cyclosporine A and mycophenolate mofetil.