The following is a summary of “Ocular Mucous Membrane Pemphigoid: The Effect of Risk Factors at Presentation on Treatment Outcomes,” published in the March 2024 issue of Ophthalmology by Ruiz-Lozano et al.

Researchers conducted a retrospective study to examine how risk factors at diagnosis affect the efficacy of long-term immunosuppressive therapy (IMT) outcomes in ocular mucous membrane pemphigoid (OMMP).

They categorized the method into four aspects: firstly, inflammatory control, defined as the absence of conjunctival inflammation in both eyes after three months of immunosuppressive therapy (IMT); secondly, relapse, characterized by new-onset inflammation following initial absolute control in either eye; thirdly, progression, denoting advancement to at least one cicatrizing stage in either eye; and lastly, vision loss, indicated by a decline of more than two Snellen lines.

The results showed that of 117 patients (234 eyes), 61% (71/117) were women, with a mean age of 66.6 (SD 12.4, range: 37–97) years. The median follow-up was 34 ( IQR Q1 16, Q3 66; range: 3–265) months. Inflammatory control was achieved in 57% (67/117) of patients. High-risk EOM (HR-EOM), which included esophageal, nasopharyngeal, and genital involvement, had an adjusted OR (aOR) of 12.51 (95% CI, 2.61–59.99; P=0.002) and corneal scarring had an aOR of 3.06 (95% CI, 1.15–8.14; P=0.025) as significant risk factors for persistent inflammation. Disease relapse occurred in 20% (23/117) of patients, progression in 12% (14/117), and vision loss in 27% (32/117). Baseline corneal scarring was a risk factor for relapse (adjusted hazard ratio 4.14; 95% CI, 1.61–10.62; P=0.003), progression (aOR 11.46; 95% CI, 1.78–73.75; P=0.010), and vision loss (aOR 3.51; 95% CI, 1.35–9.10, P=0.010). HR-EOM was associated with stage progression (aOR 34.57; 95% CI, 6.57–181.89; P<0.001) and vision loss (aOR 8.42; 95% CI, 2.50–28.42, P=0.001)—no significant differences between IMT regimes and relapse (P=0.169).

Investigators concluded that OMMP with HR-EOMs and corneal scarring indicates a higher risk of vision loss, suggesting a need for a combined staging system for a better prognosis.

Source: aaojournal.org/article/S0161-6420(24)00167-2/abstract