Utility of Direct Immunofluorescence using buccal mucosal biopsies in those with suspected isolated Ocular Mucous Membrane Pemphigoid

To determine the rate of positivity of immunofluorescence studies in buccal biopsies in patients with cicatrizing conjunctivitis undergoing workup for Ocular Mucous Membrane Pemphigoid/ocular cicatricial pemphigoid (OCP). Retrospective cohort review PARTICIPANTS: Forty-one patients with cicatrizing conjunctivitis undergoing workup for OCP METHODS: A retrospective chart review of direct immunofluorescence studies in buccal mucosal biopsies was performed. Primary outcome measure was the rate of positivity of direct and indirect immunofluorescence studies on buccal mucosal biopsies. Twenty-two (54%) patients had a positive buccal mucosal biopsy: 64% (14/22) patients demonstrated +DIF on initial biopsy, and an additional 36% (8/22) patients on second biopsy. There were 4/41 (10%) patients with a negative conjunctival biopsy that had a positive buccal mucosal biopsy. Buccal mucosal immunofluorescence studies may be positive in patients with OCP even in the absence of extraocular disease. Buccal mucosal biopsy may be considered as an alternative to or attempted prior to conjunctival biopsy for the diagnosis of ocular cicatricial pemphigoid, particularly in patients in which conjunctival biopsy may be difficult or imminently visually threatening.