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Technique of Conjunctival Biopsy and Direct Immunofluorescence for Diagnosing Mucous Membrane Pemphigoid
Published on: June 17, 2025
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Characterization of Progressive Cicatrizing Conjunctivitis With Negative Immunofluorescence Staining
Jae Young You1, Charles G Eberhart2, Sezen Karakus1
1Ocular Surface Diseases and Dry Eye Clinic, Division of Cornea and External Diseases, The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
American Journal of Ophthalmology
|September 28, 2019
Summary
Mucous membrane pemphigoid (MMP) can be diagnosed even with negative direct immunofluorescence (DIF) biopsies. High suspicion for MMP is crucial in patients with severe conjunctival scarring, even without positive DIF results.
Area of Science:
- Ophthalmology
- Immunodermatology
Background:
- Mucous membrane pemphigoid (MMP) is a rare autoimmune blistering disease.
- Direct immunofluorescence (DIF) is a key diagnostic tool for MMP.
- DIF-negative cases present diagnostic challenges.
Purpose of the Study:
- To characterize the clinical features of patients with DIF-negative MMP.
- To identify diagnostic clues for MMP in the absence of positive DIF findings.
Main Methods:
- Retrospective case series of 36 patients with suspected MMP undergoing conjunctival biopsy.
- Collection of demographic and clinical data, including visual acuity and Foster stage.
- Analysis of outcomes such as extraocular involvement and follow-up duration.
Main Results:
- Eleven patients were diagnosed with biopsy-negative MMP, showing conjunctival scarring progression.
- Biopsy-negative MMP patients had significantly lower visual acuity at presentation compared to other cicatrizing conjunctivitis cases.
- Both biopsy-positive and biopsy-negative MMP groups presented with higher conjunctival scarring scores (Foster stage 3) than other causes.
Conclusions:
- Progressive cicatrizing conjunctivitis may indicate MMP even without positive DIF.
- Maintain high suspicion for MMP in patients with Foster stage 3 conjunctival scarring or worsening scarring, irrespective of DIF results.
