Related Experiment Video
Updated: Oct 3, 2026
Technique of Conjunctival Biopsy and Direct Immunofluorescence for Diagnosing Mucous Membrane Pemphigoid
Published on: June 17, 2025
Prospective management of biopsy-proven ocular mucous membrane pemphigoid using an inflammation-oriented stepladder
Konstantina Bachtalia1, Veatriki Athanasiou2, Aikaterini Athanasiadou3
1Department of Biomedical Sciences, University of West Attica (UNIWA), Athens, Greece.
Objective/Purpose:
To prospectively describe the implementation and clinical outcomes of an inflammation-oriented management strategy for biopsy-proven ocular mucous membrane pemphigoid (MMP), in which the maximum conjunctival inflammation grade of the more severely affected eye was used to assign the initial treatment-intensity tier.
Design:
Prospective cohort study.
Participants:
Forty-eight (48) patients (96 eyes) with biopsy-proven ocular MMP.
Methods:
Patients with biopsy-confirmed ocular MMP were prospectively managed between 2018 and 2025 using an inflammation-oriented stepladder treatment protocol. Moderate to severe cases received intravenous cyclophosphamide or rituximab, while milder cases were treated with oral mycophenolate mofetil. Clinical outcomes, treatment response, disease relapse, and treatment-related adverse events were prospectively recorded.
Results:
Disease activity at presentation was minimal in 1 patient (2.1%), mild in 28 (58.3%), moderate in 7 (14.6%), and severe in 12 (25.0%). . Initial treatment corresponded to the intended inflammation-based tier in 46 patients (95.8%). Complete inflammatory control (grade 0 in both eyes) was achieved in 23 patients (47.9%) at a median of 9 months (range, 3-12 months), and 3 patients (6.3%) subsequently achieved drug-free remission. During follow-up, disease relapse occurred in 6 patients (12.5%), all of whom were successfully managed with escalation of systemic immunosuppression. At final follow-up, no eyes demonstrated moderate or severe inflammation. Treatment-related adverse events were manageable, with mycophenolate mofetil dose reduction required in 5 patients (10.4%). No treatment-related deaths occurred.
Conclusion:
This prospective study supports the implementation and clinical outcomes of an inflammation-oriented management protocol for biopsy-proven ocular MMP. Future comparative studies are warranted to validate this approach and determine its broader clinical utility.
