June 2020
Volume 61, Issue 7
Open Access
ARVO Annual Meeting Abstract  |   June 2020
Clinical outcomes of patients with ocular mucous membrane pemphigoid (OcMMP) based on their direct immunofluorescence (DIF) biopsy results
Author Affiliations & Notes
  • Kaki Tsang
    Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, West Midlands, United Kingdom
  • Liying Low
    Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, West Midlands, United Kingdom
  • Matthew Davidson
    Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, West Midlands, United Kingdom
  • Kusy Suleiman
    Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, West Midlands, United Kingdom
  • Graham R Wallace
    Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, West Midlands, United Kingdom
  • Saaeha Rauz
    Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, West Midlands, United Kingdom
  • Footnotes
    Commercial Relationships   Kaki Tsang, None; Liying Low, None; Matthew Davidson, None; Kusy Suleiman, None; Graham Wallace, None; Saaeha Rauz, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science June 2020, Vol.61, 2801. doi:
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      Kaki Tsang, Liying Low, Matthew Davidson, Kusy Suleiman, Graham R Wallace, Saaeha Rauz; Clinical outcomes of patients with ocular mucous membrane pemphigoid (OcMMP) based on their direct immunofluorescence (DIF) biopsy results. Invest. Ophthalmol. Vis. Sci. 2020;61(7):2801.

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

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Abstract

Purpose : The First International Consensus on MMP guidance recommends that DIF-positive (DIF+ve) biopsy is required for a diagnosis of OcMMP. Nevertheless, DIF-negative (DIF-ve) MMP patients are recognised in the ocular cohort who have a differing, and possibly more severe disease course. The aim of this study was to determine whether DIF-status had an impact on the clinical outcomes.

Methods : OcMMP patients reviewed in a single centre over a one year period were phenotyped according to disease course, immunosuppression and need for oculoplastic surgery as surrogate markers for disease activity and damage, respectively. These data were included in a meta-analysis of published data using the Mantel-Haenszel random effects model (PROSPERO ID:CRD42019154027). Electronic databases (OVID MEDLINE, EMBASE, Cochrane Library) were systematically searched from inception to October 10, 2019 and clinical outcomes stratified according to DIF status were independently collected by two investigators.

Results : Our Cohort:
Sixty-nine patients [DIF+ve, 50(72%); Female, 41(59%); aged 65(IQR 58 - 73) years; BMI 28.2(23.9 – 31.3)] fulfilling the current criteria for MMP, had no difference between baseline characteristics or requirement for systemic immunosuppression or surgery when stratified into DIF+ve and DIF-ve groups. While patients were equally symptomatic using OSDI, DIF-ve patients had higher Ocular Surface Staining scores compared to DIF+ve patients (DIF+ve median OSS score: 3/12, DIF-ve 5/12, p=0.022).

Meta-analysis:
Of the 4083 studies identified, 5 studies with 231 OcMMP patients [DIF+ve, 154 (67%)] were included in the meta-analysis. OcMMP patients with DIF+ve had higher pooled odds of being treated with systemic immunosuppression [OR 2.29 (95%CI 1.10 – 4.78), I2 = 0%, p=0.03], and consequently, lower pooled odds of requiring eyelid surgery [OR 0.49(95%CI 0.25 – 0.95), I2=0%, p=0.03] compared to DIF-ve patients.

Conclusions : As DIF-ve patients were less likely to be started on systemic immunosuppression and more likely to require eyelid surgery, these data infer that DIF-ve OcMMP is more likely to have progressive conjunctival fibrosis. We recommend that DIF-ve patients, with clinical phenotype suggestive of OcMMP, should be treated with systemic immunomodulatory and anti-fibrotic therapy to limit progression of disease.

This is a 2020 ARVO Annual Meeting abstract.

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