ArticleAJO international2026
Prospective management of biopsy-proven ocular mucous membrane pemphigoid using an inflammation-oriented stepladder treatment strategy.
Article in AJO international, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Objective/Purpose: To prospectively describe the implementation and clinical outcomes of an inflammation-oriented management strategy for biopsy-proven ocular mucous membrane pemphigoid (MMP), in which the maximum conjunctival inflammation grade of the more severely affected eye was used to assign the initial treatment-intensity tier. Design: Prospective cohort study. Participants: Forty-eight (48) patients (96 eyes) with biopsy-proven ocular MMP. Methods: Patients with biopsy-confirmed ocular MMP were prospectively managed between 2018 and 2025 using an inflammation-oriented stepladder treatment protocol. Moderate to severe cases received intravenous cyclophosphamide or rituximab, while milder cases were treated with oral mycophenolate mofetil. Clinical outcomes, treatment response, disease relapse, and treatment-related adverse events were prospectively recorded. Results: Disease activity at presentation was minimal in 1 patient (2.1%), mild in 28 (58.3%), moderate in 7 (14.6%), and severe in 12 (25.0%). . Initial treatment corresponded to the intended inflammation-based tier in 46 patients (95.8%). Complete inflammatory control (grade 0 in both eyes) was achieved in 23 patients (47.9%) at a median of 9 months (range, 3-12 months), and 3 patients (6.3%) subsequently achieved drug-free remission. During follow-up, disease relapse occurred in 6 patients (12.5%), all of whom were successfully managed with escalation of systemic immunosuppression. At final follow-up, no eyes demonstrated moderate or severe inflammation. Treatment-related adverse events were manageable, with mycophenolate mofetil dose reduction required in 5 patients (10.4%). No treatment-related deaths occurred. Conclusion: This prospective study supports the implementation and clinical outcomes of an inflammation-oriented management protocol for biopsy-proven ocular MMP. Future comparative studies are warranted to validate this approach and determine its broader clinical utility.
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