Ocular Cicatricial Pemphigoid With IgM-Positive Biopsy.

PURPOSE: The aim of this study was to investigate the prevalence of IgM along the basement membrane zone (BMZ) of patients with ocular cicatricial pemphigoid (OCP) and the outcomes of these patients with immunomodulatory therapy. METHODS: This study is a retrospective chart review of patients with conjunctival biopsy-proven OCP. Clinical data, including the presence of linear IgM deposition along the BMZ on either direct immunofluorescence or avidin-biotin complex immunohistochemistry, were recorded. Response to IMT was also recorded. RESULTS: A total of 817 patients with documented conjunctival biopsies were identified, with 93 (11.4%) positive for OCP with linear IgM deposition along the BMZ. Forty-six patients with sufficient follow-up were evaluated for clinical outcomes, with 35 (76.1%) able to achieve durable remission an average of 24.3 months after initiation of IMT. Most of these patients, 82.9%, were able to achieve durable remission with first-line antimetabolite therapy. Three patients were identified with solely IgM-positive conjunctival biopsies. CONCLUSIONS: Our study suggests that IgM positivity is seen in a minority of patients with OCP and that outcomes are comparable for these patients to the general OCP patient population.

Ocular Mucus Membrane Pemphigoid: A Primary Versus Secondary Entity.

PURPOSE: The purpose of this review was to investigate the idea that inflammatory events of the conjunctiva and ocular surface may act as triggering events for the onset of ocular mucus membrane pemphigoid (oMMP). METHODS: A retrospective chart review of patients with biopsy-proven oMMP and no systemic pemphigoid disease. The presence, or absence, of the following inflammatory conditions at the time of OMMP diagnosis was noted: significant eyelid disease, significant atopic eye disease, Stevens-Johnson syndrome, graft-versus-host disease, viral keratitis, sarcoidosis with ocular involvement, chemical burns, medicamentosa, Sjogren syndrome, systemic lupus erythematosus with ocular involvement, and epidemic keratoconjunctivitis. Response to immunomodulatory therapy (IMT) was also recorded. RESULTS: A total of 779 patient records were identified. Conjunctival biopsy was present in 724 patients, with 646 (89.2%) being positive. One hundred thirty-nine patients (21.5%) with positive biopsies had extraocular pemphigoid disease and were excluded from further analysis. Of the 507 included patients, 154 (30.4%) had at least one of the specified inflammatory conditions present at the time of OMMP diagnosis. One hundred eighteen patients (23.3%) had only 1 such condition, 35 (6.9%) had 2, and 1 patient had 3. In patients with at least one of these conditions present, response to IMT was seen in 84.9% of patients with sufficient follow-up. CONCLUSIONS: Our study suggests that oMMP may arise as a secondary pathology to acute inflammatory events or chronic inflammatory states of the conjunctiva and ocular surface.

Lipodermoid Cyst: A Report of a Rare Caruncular Case.

Ocular lipodermoid cysts and solid dermoid tumors are choristomas which are described as normal tissue growth in an abnormal location. Congenital epibulbar lipodermoid comprises adipose tissue that is covered by connective tissue. They are usually located superotemporally, and basically tend not to involve the peripheral cornea. If the dermoid or lipodermoid is accompanied by other systemic conditions or ocular anomalies in young children, a consultation with an Internist or pediatrician is required to rule out Goldenhar syndrome which is a oculoauriculovertebral dysplasia. This paper reports a unilateral lipodermoid cyst which is remarkable regarding its caruncular origin, in an otherwise healthy adult female.

Efficacy of a Modified Bier's Block in Patients Undergoing Upper Limb Bone Surgery.

BACKGROUND: Intravenous regional block, called the Bier's block, refers to an analgesic technique applied for soft tissue surgeries and closed bone manipulations of the limbs. There are a number of complications in traditional method of block, including pain in tourniquet site, immediate return of pain after tourniquet deflation, wound hemostasis and some others. OBJECTIVES: The aim of this study was to assess the outcomes and complications of our new method of blockage. PATIENTS AND METHODS: In this experimental study, twenty-five patients undergoing hand surgery were prospectively studied. Induced anesthesia was a modification of the Bier's block with two concurrent changes including insertion of the intravenous cannula at the antecubital region rather than distal and the proximal anesthetic direction by an elastic band wrapped tightly around the proximal forearm distal to the cannulation site. The pain relief was measured by the verbal descriptive scale at intervals after block, during the operation, after deflation of the tourniquet and one hour after the operation. RESULTS: This study showed the presence of analgesia at surgical and tourniquet sites during the operation in 96% of patients, as well as considerable pain relief at surgical site during one hour after deflation of the tourniquet. CONCLUSIONS: The study indicated advantages of this modified Bier's block compared to the traditional one including ability to perform surgery on upper limb bones and considerable pain relief at surgical and tourniquet sites during the operation until one hour thereafter.