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Arriozola Rodriguez Karen Janeth, Monica Almanza Monterrubio, Miguel Pedroza-Seres; Epidemiology of cicatricial conjunctivitis in a reference ophthalmological center of Mexico City. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):861.
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© ARVO (1962-2015); The Authors (2016-present)
To analyze the characteristics of cicatricial conjunctivitis in a tertiary eye center in Mexico.
We review electronic charts of patients with diagnosis of cicatricial conjunctivitis between 2001 and 2014. Infectious etiology of conjunctival scarring were ruled out. Information on demographic characteristics, ophthalmologic examination, systemic illness, medications and results of conjunctival biopsies were used for this analysis. Patients with mucous membrane pemphigoid with ocular involvement (ocular cicatricial pemphigoid) were classified according to Foster's classification.
From a total of 847 patients with diagnosis of cicatricial conjunctivitis, 104 were included in the study. 71 (68%) were female and 34 (32%) male. The mean age at presentation was 61.7 years. 41 patients (39%) were diagnosed with ocular cicatricial pemphigoid, 16 (16%) pseudopemphigoid, 16 (15%) Steven's Johnson syndrome and 15 (14%) chronic unspecific conjunctivitis. Other diagnosis were pemphigus, Sjogren syndrome, squamous cell carcinoma, linear IgA bullous dermatosis. Conjunctival biopsies were made in 40 patients (38%), 14 (35%) were positive to ocular cicatricial pemphigoid, 13 (32%) to chronic unspecific conjunctivitis, 5 (12.5%) to pemphigus vulgar. Most of the patients with cicatricial conjunctivitis had ocular cicatricial pemphigoid and 20 (50%) were stage 3, 13 (32%) stage 2 and 6 (15%) stage 1 at initial visit and at the end 5 (12%) were stage 1, 7 (17%) stage 2, 21 (52%) stage 3 and 4 (1%) progress to stage 4. The mean visual acuity in this group was 0.78 at first visit and 0.79 LogMar at last one. Follow-up time varies from 1 month to 8 years. A total of 65% of patients with ocular cicatricial phemphigoid showed clinical activity of the disease and required systemic immunosupressor medication for control: 20 (74%) patients received oral steroid, 14 (51%) diamino-diphenyl-sulfone, 11 (40%) methotrexate, 9 (33%) azathioprine, 7 (27%) cyclophosphamide and 1 (3%) mycophenolate mophetil. Of all these patients 20 (74%) required two or more systemic medication due to poor control or recurrent reactivation.
The main diagnosis of cicatricial conjunctivitis in our study was mucous membrane pemphigoid with ocular involvement. Patients with ocular cicatricial pemphigoid are seen in an advanced clinical stage. This is the first study of the causes of cicatricial conjunctivitis in our media.
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