Increased reliability of diagnosis of ocular cicatricial pemphigoid using avidin-biotin complex immunoperoxidase technique

Abstract

 

Purpose

 

To demonstrate the effectiveness of conjunctival biopsy analyzed via histopathology and direct immunofluorescence (DIF) supplemented by avidin-biotin complex (ABC) immunoperoxidase in the diagnosis of ocular cicatricial pemphigoid (OCP) and report outcomes of therapy.

 

Methods

 

Review of 95 consecutive patients between 2008 and 2010 with conjunctival biopsy for suspected OCP analyzed using histopathology and DIF, supplemented by ABC in high suspect DIF negative or inconclusive cases. Data regarding clinical characteristics, history of previous biopsy, biopsy outcomes, treatment, and clinical response to therapy after biopsy were gathered.

 

Results

 

Sixty-nine of 95 patients (73%) were diagnosed with OCP, and 20 of 69 (29%) required use of ABC to confirm diagnosis. Sensitivity increased from 66% with DIF to 93% with DIF and ABC. Thirty-eight OCP positive patients with available follow up required immunomodulatory therapy (IMT), and 35 of 38 (92%) achieved durable remission. Twenty of all 69 OCP positive patients were diagnosed using ABC. Ten with available follow up required IMT, and all 10 (100%) achieved remission. Thirty of all 95 patients had previous biopsy elsewhere, 7% were positive; after repeat biopsy, 80% of these were diagnosed with OCP, 53% by DIF alone and an additional 27% by ABC. In this group, sensitivity increased from 8% after previous biopsy to 64% with DIF and 96% with DIF and ABC. Fifteen of these with available follow up required IMT, and 14 (93%) achieved remission. Of the 28 who had previous negative biopsy, 22 were diagnosed with OCP (79%), and 8 of these 22 required ABC (29%). Six of these 8 with available follow up required IMT, and all 6 (100%) achieved remission.

 

Conclusions

 

Conjunctival biopsy analyzed by histopathology and DIF supplemented by ABC immunoperoxidase increases the diagnostic yield of OCP in patients with chronic cicatrizing conjunctivitis suspicious for OCP. There should be strong consideration for ABC as a standard supplement for diagnosis of OCP in DIF negative or inconclusive cases. More accurate and earlier detection of OCP using this diagnostic method allows earlier initiation of therapy and better outcomes.

 

 

Forniceal foreshortening and symblephara in ocular cicatricial pemphigoid.

 

 

Conjunctival biopsy analyzed by: A) direct immunofluorescence with positive BMZ; B) avidin-biotin complex immunoperoxidase with positive BMZ.

 

Keywords: 475 conjunctivitis • 554 immunohistochemistry • 639 pathology techniques