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S. S. Siddique, M. Mehta, C. S. Foster; Immunohistopathologic Study of Fibrinogen in Normal Conjunctiva and in Conjunctiva Affected by Cicatrizing Conjunctivitis. Invest. Ophthalmol. Vis. Sci. 2010;51(13):6316.
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© ARVO (1962-2015); The Authors (2016-present)
Fibrinogen is not a normal constituent of oral mucosa,and its presence,detected on immunohistochemical analysis of biopsied inflamed mucosa is considered indicative of lichen planus or other pathologic conditions.We have noticed,from reports received from elsewhere,a widespread misinterpretation by pathology laboratories on the presence of fibrinogen at the basement membrane zone (BMZ) of conjunctiva,leading to the erroneous diagnosis of conjunctival lichen planus or other pathology,including suspicion of ocular cicatricial pemphigoid (OCP).This misdiagnosis can lead to long term treatment with potentially harmful drugs. We have demonstrated the presence of fibrinogen at the epithelial BMZ of normal and inflamed human conjunctiva.In fact,this glycoprotein can serve as a useful positive control in the immunohistochemical study of conjunctival biopsies.We now aim to further characterize the patterns of this fibrinogen layer at the BMZ in various ocular forms of cicatrizing conjunctivitis.
Bulbar conjunctiva was obtained from 50 healthy adults undergoing cataract surgery with no history of ocular disease or use of ocular medication.Fifty specimens were obtained from patients with chronic conjunctivitis(duration more than 6 months)due to various diseases other than OCP.The specimens were snap frozen in liquid nitrogen,embedded in Tissue Tek OCT compound and sectioned.Immunofluorescent staining was performed with the following primary antibodies:goat anti-human albumin(negative control),goat anti-human fibrinogen(1:16 and 1:20 dilutions)and goat anti-human collagen-IV.The secondary fluorescent antibodies used were fluorescein isothiocyanate(FITE)or tetramethyl rhodamine isothiocyanate(TRITC).The stained sections were then analyzed by 2 masked observers with a Zeiss Photomic III microscope.
Fibrinogen was present at the BMZ of both normal and inflamed conjunctiva.Fibrinogen was also present around conjunctival vessels.Type IV collagen was found as an intensely staining,continuous band at the epithelial BMZ of normal and inflamed conjunctiva and around all vessels.
Fibrinogen at the BMZ is a normal component of conjunctiva;its presence should not be considered indicative of pathology.We intend to further conduct a prospective,blinded IRB approved study to compare the immunohistopathologic differences in conjunctival fibrinogen between normal conjunctiva and cicatrizing disorders to see if there are specific diagnostic patterns of fibrinogen and quantitative reduction in goblet cells in various types of chronic cicatrizing conjunctivitis.
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