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Kazunari Higa, Yoshiyuki Satake, Daisuke Tomida, Katsuya Yamazoe, Takahiko Hayashi, Naoki Toriyama, Jun Shimazaki; Immunohistochemical alterations in cicatricial conjunctivitis associated with Behcet’s disease. Invest. Ophthalmol. Vis. Sci. 2013;54(15):2123.
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To identify the pathogenesis of cicatricial conjunctivitis in Behcet’s disease and to evaluate the histopathological differences from ocular cicatricial pemphigoid (OCP) .
Conjunctival resection samples were obtained from patients with OCP and Behcet’s disease during corneal oral mucosa epithelial sheet transplantation, penetrating keratoplasty or cataract surgery. All subjects underwent tear and ocular surface examinations including slit lamp microscopy, Schirmer test, tear clearance, fluorescein vital stainings. Informed consents were obtained, the procedures were board reviewed and registered at Tokyo Dental College, Ichikawa Hospital. The tissues were mounted with the OCT compound and frozen sections were stained with hematoxylin & eosin initially. Immunohistochemistry (IHC) for differentiation of inflammatory cells including CD 3, 4 and 8, CD11c, CD68, CD66c, and alpha-SMA stainings were performed. In addition, IHC alterations of the supracorneal conjunctival tissues were studies with keratin 4, 13 and involucrin antibodies. CD31, podoplanin IHC stainings were also performed.
None of the subjects had any systemic and ocular disease other than OCP or Behcet’s disease or drug use that would cause cicatricial conjunctivitis. Prominent stainings were observed exclusively in the stromal sections of the supracorneal conjunctival tissues for CD3, CD4, CD8, CD11c, CD68, CD66c,CD31 and alpha-SMA in Behcet’s disease. On the other hand, while conjunctival samples from OCP patients showed similar staining patterns to Behcet’s disease in the stromal tissues, OCP sections also showed remarkable positive staining of these markers in the epithelium. Interestingly, decreased keratin 4 and 13 (mucosal epithelium) stainings with prominent increase in involucrin staining were observed in conjunctival epitheliae of subjects with Behcet’s disease.
Conjunctival ocular surface disorder in Behcet’s disease differed from OCP in relation to presence of prominent staining for inflammatory markers in the conjunctival stroma and increased staining for keratinization markers in the epithelium. Our findings suggest a prominent role for conjunctival stromal vasculitis in Behcet’s conjunctival epithelial disease whereas concomitant epithelitis and vasculitis appear to be important in the pathogenesis of the conjunctival changes in OCP .
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