Ocular cicatricial pemphigoid with granular IgA and complement deposition.

Area of Science:

• Ophthalmology
• Immunology
• Pathology

Background:

• Chronic conjunctival scarring, including symblepharon, can lead to significant visual impairment.
• The pathogenesis of progressive conjunctival scarring is not fully understood, with autoantibodies implicated in some cases.

Observation:

• A 65-year-old woman presented with chronic bilateral eye redness and progressive conjunctival scarring over 2.5 years.
• Biopsies revealed epithelial separation, subepithelial inflammation, and scarring.
• Direct immunofluorescence showed granular IgA and C3 deposition along the epithelial basement membrane zone.

Findings:

• Electron microscopy confirmed deposits consistent with antigen-antibody complexes.
• IgA and C3 deposition along the epithelial basement membrane zone suggests an immune-complex-mediated process.

Implications:

• Antigen-antibody (IgA) immune-complex deposition may represent an alternative pathway in the development of progressive conjunctival scarring.
• This finding could lead to new diagnostic approaches and therapeutic strategies for patients with immune-mediated conjunctival diseases.