April 2014
Volume 55, Issue 13
Free
ARVO Annual Meeting Abstract  |   April 2014
Interpretation and clinical correlation of histopathology and immunohistochemistry findings in conjunctival and scleral biopsy specimens: non-infectious and infectious
Author Affiliations & Notes
  • Stephen D Anesi
    Massachusetts Eye Rsch & Surg Inst, Cambridge, MA
  • Srishti Kothari
    Massachusetts Eye Rsch & Surg Inst, Cambridge, MA
  • C Stephen Foster
    Massachusetts Eye Rsch & Surg Inst, Cambridge, MA
  • Footnotes
    Commercial Relationships Stephen Anesi, None; Srishti Kothari, None; C Stephen Foster, None
  • Footnotes
    Support None
Investigative Ophthalmology & Visual Science April 2014, Vol.55, 1867. doi:
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      Stephen D Anesi, Srishti Kothari, C Stephen Foster; Interpretation and clinical correlation of histopathology and immunohistochemistry findings in conjunctival and scleral biopsy specimens: non-infectious and infectious. Invest. Ophthalmol. Vis. Sci. 2014;55(13):1867.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract
 
Purpose
 

Many forms of ocular inflammatory disease have similar, and sometimes indistinguishable, presentations. We aim to report normal baseline characteristics of human conjunctiva and sclera examined via histology and immunohistochemistry, and compare them to findings expected in various disease processes, non-infectious and infectious. Information obtained via biopsy can help to distinguish between differing etiologies of ocular inflammatory disease when clinical exam, testing, and other laboratory data are unable to confirm a diagnosis. This information can be critical in the initial determination of therapy, and while changing therapy when doubts arise about a working diagnosis based on a failed response to a current regimen.

 
Methods
 

Reports of conjunctival and scleral biopsies obtained from patients with various suspected ocular surface diseases were reviewed and summarized. Information based on years of author experience with biopsies was also included. Biopsies were processed in a similar fashion, unless otherwise specified by clinical suspicion. Hematoxylin and eosin, periodic acid-Schiff, and Giemsa stains were performed on each specimen. Direct immunofluorescence included antibodies against IgA, IgG, IgM, C3, C4, IgE, IgD, fibrinogen, albumin, and collagen IV, and was performed on each specimen as well. When clinical suspicion warranted, specimens were also analyzed via direct immunofluorescence of antibodies against herpes simplex (HSV) and varicella zoster virus (VZV) antigens, in serial dilutions. All studies were compared with appropriate controls at the time of reading.

 
Results
 

Findings of both normal conjunctiva and sclera, examined using histology and immunohistochemistry, are reported here. Findings in various pathologic conditions, including chronic conjunctivitis, scleritis, and infectious/viral ocular surface disease are also reported.

 
Conclusions
 

We demonstrate expected histologic and immunohistochemical findings in normal conjunctival and scleral biopsies, and also report how these findings differ in various infectious and noninfectious conditions affecting the ocular surface and scleral wall. We hope that this will further aid in the diagnosis and eventual management of these conditions, or help augment clinical suspicion in cases where data is otherwise inconclusive.

   
 
Conjunctiva with BMZ positivity to IgA.
 
Conjunctiva with BMZ positivity to IgA.
 
Keywords: 638 pathology: human • 474 conjunctiva • 599 microscopy: light/fluorescence/immunohistochemistry  
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