Ocular Mucous Membrane Pemphigoid Presenting as Recurrent Pterygium.
Journal
Cornea
ISSN: 1536-4798
Titre abrégé: Cornea
Pays: United States
ID NLM: 8216186
Informations de publication
Date de publication:
29 Aug 2024
29 Aug 2024
Historique:
received:
11
04
2024
medline:
31
8
2024
pubmed:
31
8
2024
entrez:
29
8
2024
Statut:
aheadofprint
Résumé
The aim of this series was to report recurrent pterygium as a presenting feature of ocular mucous membrane pemphigoid (oMMP). A retrospective review was performed, and patients with biopsy positive oMMP who presented with recurrent pterygia were included. Data on the demographic profile, clinical characteristics, and details of the surgical intervention were collected. A total of 5 patients with recurrent pterygium were included. All the patients were men. The median age was 63 years. History of pterygium surgery was present in 8/10 eyes (80%), of which 6 eyes (60%) developed a recurrent pterygium. A symblepharon was present in 4/6 eyes (67%). Forniceal shortening was present in 10/10 (100%) eyes. All eyes were subjected to a conjunctival biopsy for direct immunofluorescence, of which 9 eyes (90%) had positive results consistent with oMMP. Systemic immunomodulatory therapy (IMT) with either methotrexate or azathioprine was initiated in all 5 patients. Recurrent pterygium can be a presenting feature of oMMP. The presence of symblepharon formation or forniceal shortening, especially in the fellow eye, warrants a conjunctival biopsy and prompt initiation of IMT to prevent disease progression.
Identifiants
pubmed: 39208355
doi: 10.1097/ICO.0000000000003683
pii: 00003226-990000000-00674
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Subventions
Organisme : Hyderabad Eye Research Foundation
Informations de copyright
Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
The authors have no conflicts of interest to disclose.
Références
Branisteanu DC, Stoleriu G, Branisteanu DE, et al. Ocular cicatricial pemphigoid (review). Exp Ther Med. 2020;20:3379–3382.
Singh C, Jain N, Sharma S, et al. Vortex keratopathy as a presenting feature of ocular mucous membrane pemphigoid. Cornea. 2023;42:1454–1457.
Sgrulletta R, Lambiase A, Micera A, et al. Corneal ulcer as an atypical presentation of ocular cicatricial pemphigoid. Eur J Ophthalmol. 2007;17:121–123.
Rezvan F, Khabazkhoob M, Hooshmand E, et al. Prevalence and risk factors of pterygium: a systematic review and meta-analysis. Surv Ophthalmol. 2018;63:719–735.
Liu L, Wu J, Geng J, et al. Geographical prevalence and risk factors for pterygium: a systematic review and meta-analysis. BMJ Open. 2013;3:e003787.
Das AV, Podila S, Prashanthi GS, et al. Clinical profile of pterygium in patients seeking eye care in India: electronic medical records-driven big data analytics report III. Int Ophthalmol. 2020;40:1553–1563.
Hirst LW. The treatment of pterygium. Surv Ophthalmol. 2003;48:145–180.
Fonseca EC, Rocha EM, Arruda GV. Comparison among adjuvant treatments for primary pterygium: a network meta-analysis. Br J Ophthalmol. 2018;102:748–756.
Clearfield E, Hawkins BS, Kuo IC. Conjunctival autograft versus amniotic membrane transplantation for treatment of pterygium: findings from a Cochrane Systematic Review. Am J Ophthalmol. 2017;182:8–17.
Vazirani J, Donthineni PR, Goel S, et al. Chronic cicatrizing conjunctivitis: a review of the differential diagnosis and an algorithmic approach to management. Indian J Ophthalmol. 2020;68:2349–2355.
Kate A, Doctor MB, Basu S. Drug-induced pemphigoid: clinical presentation, diagnosis, and management of gliptin-associated cicatrizing conjunctivitis. Ocul Surf. 2022;26:50–52.
Donthineni PR, Doctor MB, Shanbhag S, et al. Aqueous-deficient dry eye disease: preferred practice pattern guidelines on clinical approach, diagnosis, and management. Indian J Ophthalmol. 2023;71:1332–1347.
Mondino BJ, Brown SI. Ocular cicatricial pemphigoid. Ophthalmology. 1981;88:95–100.
Jain N, Jakati S, Shanbhag SS, et al. Direct immunofluorescence findings and factors affecting conjunctival biopsy positivity in ocular mucous membrane pemphigoid. Cornea. 2024;43:159–165.
Mudhar HS. Biopsies of cicatricial conjunctivitis cases reveal highly variable sampling practice among ophthalmologists: time for national and international standardisation. Br J Ophthalmol. 2016;100:736–744.
Kate A, Basu S. Systemic immunosuppression in cornea and ocular surface disorders: a ready reckoner for ophthalmologists. Semin Ophthalmol. 2022;37:330–344.
Kate A, Shanbhag SS, Donthineni PR, et al. Role of topical and systemic immunosuppression in aqueous-deficient dry eye disease. Indian J Ophthalmol. 2023;71:1176–1189.
Fernandes M, Sangwan VS, Bansal AK, et al. Outcome of pterygium surgery: analysis over 14 years. Eye (Lond). 2005;19:1182–1190.
Williams GP, Nightingale P, Southworth S, et al. Conjunctival neutrophils predict progressive scarring in ocular mucous membrane pemphigoid. Invest Ophthalmol Vis Sci. 2016;57:5457–5469.
Mauriello JA, Lopresti-Solis AE, DeRose DA, et al. Conjunctival scarring after eyelid surgery as first sign of ocular cicatricial pemphigoid. Ophthalmic Plast Reconstr Surg. 1994;10:142–145.
Hatton MP, Raizman M, Foster CS. Exacerbation of undiagnosed ocular cicatricial pemphigoid after repair of involutional entropion. Ophthalmic Plast Reconstr Surg. 2008;24:165–166.
Nangia V, Jonas JB, Nair D, et al. Prevalence and associated factors for pterygium in rural agrarian Central India. The Central India Eye and Medical Study. PLoS One. 2013;8:e82439.
McGlacken-Byrne AB, Drinkwater JJ, Mackey DA, et al. Gender and ethnic differences in pterygium prevalence: an audit of remote Australian clinics. Clin Exp Optom. 2021;104:74–77.
Song P, Chang X, Wang M, et al. Variations of pterygium prevalence by age, gender and geographic characteristics in China: a systematic review and meta-analysis. PLoS One. 2017;12:e0174587.
Garate-Carrillo A, Gonzalez J, Ceballos G, et al. Sex related differences in the pathogenesis of organ fibrosis. Transl Res. 2020;222:41–55.
Ghiasian L, Samavat B, Hadi Y, et al. Recurrent pterygium: a review. J Curr Ophthalmol. 2022;33:367–378.
Thompson JP, Harbin Z, Das H, et al. Comparison of pterygium recurrence rates between attending physicians and supervised trainee residents. Cornea. 2022;41:12–15.