Conjunctival Biopsy Site in Mucous Membrane Pemphigoid.

PURPOSE: To investigate if there is an association between the location of the conjunctival biopsy site (lesional, perilesional, or nonaffected) and the result of the direct immunofluorescence (DIF) test in patients with suspected mucous membrane pemphigoid (MMP) involving the ocular surface. DESIGN: Retrospective case series. METHODS: Records of patients with clinically suspected ocular MMP were reviewed to determine the location of the conjunctival biopsy. Conjunctival biopsy locations were defined as "lesional," "perilesional," and "nonaffected" conjunctiva. The DIF was considered positive when there was deposition of at least 1 of either IgM, IgG, IgA, or C3 at the basement membrane of the specimen; nondiagnostic when only fibrinogen was found at the same location; and negative when none of these features were present. RESULTS: The records of 41 patients were analyzed. Of these, 32 were eligible to be included in the study. Biopsies were lesional in 22% of cases (7/32), perilesional in 22% (7/32), and from nonaffected conjunctiva in 56% (18/32). DIF results were positive in 14% of lesional biopsies, in 86% of perilesional biopsies, and in 17% of those from nonaffected conjunctiva (P = .003). Perilesional biopsies gave higher positive DIF than lesional biopsies (P = .029). CONCLUSIONS: Perilesional conjunctival biopsies are associated with an increase in positive DIF results. These results support the need to sample perilesional conjunctival tissue in patients with suspected MMP.

Rectus Muscle Resection for Vertical Strabismus in Thyroid Eye Disease.

PURPOSE: Rectus muscle resection in thyroid eye disease (TED) is generally avoided due to the risk of worsening restriction or reactivating inflammation. However, for some patients with large-angle strabismus or diplopia in primary gaze despite maximum recession surgery, rectus muscle resection may be beneficial. We report our surgical experience with rectus muscle resection in the management of vertical strabismus associated with TED. METHODS: Retrospective review of eight patients with TED and vertical diplopia who underwent vertical rectus muscle resection by a single surgeon (IBM) at a tertiary referral centre in Liverpool, UK, from 2001 to 2013. The goal of surgery was elimination of diplopia in primary and reading position. Vertical deviations were measured in prism dioptres (∆) before and after surgery at one month, four months and final visit by prism alternate cover testing at ⅓ m and 6 m. RESULTS: The mean ± standard deviation vertical deviation for near and distance reduced significantly from 14.2∆ ± 8.4∆ and 15.8∆ ± 8.8∆ pre-operatively to 5.7∆ ± 4.9∆ and 6.7∆ ± 7∆ at the four-month visit, respectively (p< 0.05). At the four-month follow-up, five (62.5%) patients achieved binocular single vision in primary and reading position with either no prisms or prisms less than 5∆. Further recession surgery, Harada-Ito procedure, or lateral rectus resection were necessary in four (50%) patients with persistent diplopia. No patient developed recurrence of inflammation or increased muscle restriction. CONCLUSIONS: Vertical rectus resection could be considered as an additional surgical strategy in the management of TED patients with vertical strabismus without adverse sequelae.