Preferred practice patterns in the diagnosis of mucous membrane pemphigoid amongst cornea specialists

Author Block: Sarah Moussa ¹, Maya Tong², Marie-Claude Robert², Mona Harissi-Dagher², Sajjad Ahmad³, Samir Jabbour².  ¹McGill University, ²University of Montréal, ³Moorfields Eye Hospital.

Author Disclosure Block: S. Moussa:  None.  M. Tong:   None.  M. Robert:  None.   M. Harissi-Dagher:  None.  S. Ahmad:   None.  S. Jabbour:  None., Sarah Moussa: Not Current  Maya Tong: Not Current  Marie-Claude Robert: Not Current  Mona Harissi-Dagher: Not Current  Sajjad Ahmad: Not Current  Samir Jabbour: Not Current

Abstract Title: Preferred practice patterns in the diagnosis of mucous membrane pemphigoid amongst cornea specialists

Abstract Body: Purpose:  To evaluate preferred diagnostic tools and treatment decision-making factors in cases suspicious of mucous membrane pemphigoid (MMP) amongst ophthalmologists and cornea specialists.  Study Design:  Cross sectional survey  Methods:   Web-based survey, consisting of 14 multiple choice questions, posted to the Cornea Society Listserv Keranet, the Canadian Ophthalmological Society Cornea Listserv and the Bowman club Listserv.   Results:  One hundred and thirty-six ophthalmologists participated in the survey. Eighty six percent (86%) of respondents were cornea trained and practiced in either North America or Europe (83%). Most respondents (72%) routinely perform conjunctival biopsies for all suspicious cases of MMP. For those who do not, fear that biopsy will exacerbate inflammation was the most common reason to defer investigation (47%). Seventy one percent (71%) performed biopsies from perilesional sites. Ninety seven percent (97%) ask for direct (DIF) studies, and 60% for histopathology in formalin. Most do not recommend biopsy at other non-ocular sites (75%), nor do they perform indirect immunofluorescence for serum autoantibodies (68%). Immune-modulatory therapy is started following positive biopsy results for most (66%), albeit most (62%) would not let a negative DIF influence the choice of starting treatment should there be clinical suspicion of MMP.  Conclusions:  Responses to the survey suggest that there is heterogeneity in certain practice patterns for MMP. Biopsy remains an area of controversy in dictating treatment plans. Identified areas of need should be targeted in future research.